A new study based on a cohort of Brazilian infants shows those who were exposed to SARS-CoV-2 infections in the uterus may be at an increased risk for developmental delays in the first year of life. The study appeared yesterday in the International Journal of Infectious Diseases.

Women in northern Brazil were assessed from April 2020 to July 2021. Researchers compared outcomes among a case group of 69 children who were exposed to lab-confirmed COVID-19 in utero compared to 68 children who served as controls, and had no known exposure to COVID-19 in utero.

"All mothers were unvaccinated at the time of cohort inclusion, and maternal demographics were similar in the two groups," the authors wrote.

At 12 months, 20.3% of COVID-exposed children and 5.9% of the controls received a diagnosis of neurodevelopmental delay (risk ratio, 3.44; 95% confidence interval, 1.19 to 9.95).

For the exposed group, the prevalence of neurodevelopment impairment using the Ages & Stages Questionnaire (ASQ-3) was 35.7% at 4 months, 7.0% at 6 months, and 32.1% at 12 months.

Delays seen at 4, 12 months

"Over 50% of the SARS-CoV-2 exposed infants presented ASQ-3 scores below the expected cutoff, with about half classified with neurodevelopmental delay, mainly at 4 and 12 months,” the authors wrote.

Over 50% of the SARS-CoV-2 exposed infants presented ASQ-3 scores below the expected cutoff.

Previous studies conducted in the United States and elsewhere have shown a risk of delays in infants exposed to COVID-19 infections in utero, but this is the first study to look at the phenomenon in northern Brazil.

In follow-up of exposed infants, the researchers found 10% had an abnormal result on cranial ultrasonography, mainly mild ventriculomegaly, a swelling in the brain caused by cerebrospinal fluid buildup.

"That has been described with other congenital infections, like cytomegalovirus and Zika virus," they wrote. "Although the findings were mostly mild, there was an association between the diagnosis of abnormalities and the risk of developmental delay."

A systematic review and meta-analysis estimates a nearly 50% long-COVID rate months after infection in Africa, with psychiatric conditions the most common manifestations.

Published today in Scientific Reports, the February 2023 literature search and analysis involved 25 observational, English language long-COVID studies with 29,213 infected African patients.

Nearly half (48%) of the studies were from Egypt, the average patient age was 42 years (range, 7 to 73 years), 59.3% were females, and the median follow-up was 3 months.

"In low-income countries, the estimates of its [long COVID's] incidence vary greatly due to a significant number of hidden infections (i.e., asymptomatic or undisclosed) and difficulties in accessing testing," the study authors wrote.

A fourth of patients reported poor quality of life

The team, led by researchers from the University of Bari in Italy, found a long-COVID rate of 48.6%, with a predominance of psychiatric conditions, especially post-traumatic stress disorder (25.8%).

The most common neurologic symptom was cognitive impairment (15%), and shortness of breath was the most common respiratory symptom (18.3%), followed by cough (10.7%). Other notable symptoms were loss of appetite (12.7%), weight loss (10.4%), fatigue (35.4%), and muscle pain (15.5%). A quarter (25.4%) of patients reported poor quality of life.

The high incidence of fatigue is particularly worrisome because of its debilitating nature. "This is concerning because, in Africa, it has the potential to lead to important impairment in productivity and further loss of economic agency," the researchers wrote.

The study recommends identifying at-risk people and defining treatment strategies and recommendations for African long-COVID patients.

Likewise, the mental illness burden in long-COVID patients poses a challenge on a continent with few mental health resources: "These findings highlight the pressing need for immediate policy implementation and reallocation of resources to address this severely underestimated public health issue."

Risk factors for long COVID included older age and hospitalization during infection.

"The study recommends identifying at-risk people and defining treatment strategies and recommendations for African long-COVID patients," the authors concluded, noting that high-quality studies are urgently needed.

The incidence of carbapenem-resistant Enterobacterales (CRE) declined in the United States from 2016 through 2020, researchers reported yesterday in Open Forum Infectious Diseases.

Using surveillance data from seven US sites that conduct active laboratory and population-based CRE surveillance, a team led by researchers with the Centers for Disease Control and Prevention (CDC) analyzed trends in the incidence of CRE, which the CDC considers an urgent public health threat because of their ability to cause severe, multidrug-resistant infections. An incident CRE case was defined as the first isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. resistant to one or more carbapenems from a sterile site or urine.

Based on a review of patient healthcare exposure and location of disease onset, cases were defined as hospital-onset (HO), healthcare-associated community-onset (HACO), or community-associated (CA). Incidence rates were calculated using Census data, and were adjusted for sex, race/ethnicity, and age to analyze trends.

Concerted national prevention efforts

The researchers identified 4,996 CRE cases among 4,321 patients; 62% were HACO, 21% were CA, and 14% were HO. The predominant organism was Enterobacter cloacae complex, followed by Klebsiella pneumoniae and E coli. Most cases were identified from urine (89%) or blood (8%).

The crude overall CRE incidence rate per 100,000 population fell from 7.51 in 2016 to 6.08 in 2020 and was highest for HACO cases, followed by CA and HO. Compared with 2016, the adjusted overall CRE incidence rate fell by 24% in 2020 (rate ratio [RR], 0.76; 95% confidence interval [CI], 0.70 to 0.83). Significant declines in adjusted incidence rates in 2020 were observed for HACO (RR, 0.75; 95% CI, 0.67 to 0.84) and CA cases (RR, 0.75; 95% CI, 0.61 to 0.92), but not for HO-CRE, which saw increases in 2020 that were linked to the COVID-19 pandemic.

"Concerted national prevention efforts likely contributed to the decrease in CRE, including improved surveillance for CRE, prompt implementation of recommended prevention measures, and continued emphasis on antibiotic stewardship," the study authors wrote, adding that further surveillance is needed to understand post-COVID-19 pandemic changes to CRE incidence.

• Federal health officials today said the Home Test to Treat program for COVID-19 and flu has been extended. The program is led by the National Institutes of Health and its partners and is part of an effort to learn more about test-to-treat models. The program offers home testing, telehealth visits, and treatment—if needed—for uninsured and underinsured adults, as well as those who are on Medicare or Medicaid, are in the Veteran Affairs healthcare system, or receive care through the Indian Health Services.
• The Pan American Health Organization (PAHO) yesterday issued an epidemiologic alert for dengue activity, with the approach of the peak season in Southern Hemisphere countries and ongoing circulation in Central American and Mexico. The agency also said dengue serotype 3 is one of the main viruses, which hasn't circulated for years in some countries. PAHO also urged nations to press forward with surveillance and case detection. 2023 has been a record dengue year, with more than 4.1 million cases reported so far. As of the second week of November, cases are up 56% compared to the same time last year and are up 114% compared to the average for the past 5 years.
• The Coalition for Epidemic Preparedness Innovations (CEPI) yesterday announced a partnership with Jurata Thin Film, based in Houston, to advance the development of under-the-tongue mRNA vaccine films as a potential needle-free vaccine delivery platform. The partnership includes an initial $1.2 million to support development. CEPI said advantages, if successful, include a thermostable formulation that make the vaccine easier to deploy in remote areas or low-resource settings. Also, the needle-free option could avoid the complexities of needle-and-syringe administration.