- Following the discovery of dead birds on several Galapagos Islands, samples were collected and three of five were positive for highly pathogenic H5N1 avian flu in preliminary tests, according to information released by Galapagos National Park. The samples will be sent to the National Public Health Research Institute in Guayaquil on Ecuador's mainland for confirmation. Officials have closed affected sites to visitors and urged tour operators to take biosafety precautions. Technical teams from the Galapagos National Park Directorate and the Agency for Control and Regulation of Biosafety and Quarantine for Galapagos are monitoring the situation, including in endemic bird populations that include penguins and cormorants. Ecuador's Environment Minister Jose Antonio Davalos said officials will deploy all available resources to reduce the impact on the archipelago's unique ecosystem.
- Two institutions have announced grants to fund work into the diagnosis and treatment of Lyme disease, with an emphasis on the management of patients with chronic infections. Yesterday Tufts University announced $7 million in new grants, including more than $4.5 million from the Department of Defense (DOD) and the National Institutes of Health (NIH) to understand the underlying causes of chronic Lyme disease and to test a screening tool for diagnosing acute disease sooner. Veterinary researchers from the school received an $885,000 grant from Tarsus Pharmaceuticals to develop an oral drug that can be used to kill ticks that are feeding on humans. Other Tufts groups received grants from other sources to develop a test to predict chronic Lyme disease and to study the altered immune response. In a related development, Mount Sinai Hospital and School of Medicine today announced a $6.2 million research grant from the Steven & Alexandra Cohen Foundation to fund new research programs to explore the similarities and differences between long COVID and chronic Lyme disease and to expand the facility's clinical care center for patients with complex chronic illnesses.
- The World Health Organization (WHO) today detailed a botulism cluster in France linked to eating homemade preserved sardines that has so far led to 15 infections, 1 of them fatal. Investigators found that the patients had eaten in the same restaurant in Bordeaux between September 4 and September 10, when the restaurant was serving Rugby World Cup fans. Of the 15 patients, 10 were hospitalized and 8 are in intensive care. Fourteen of the patients are from six countries outside of France. Botulism is a serious neurological condition caused by a toxin produced by Clostridium botulinum, which can develop in improperly preserved foods. The incubation, as long as 8 days, suggests that more cases could be identified, the WHO said.
Quick takes: H5N1 avian flu reaches Galapagos, Lyme disease funds, botulism in France
HHS awards $45 million to support long-COVID clinics
The US Department of Health and Human Services (HHS), through its Agency for Healthcare Research and Quality (AHRQ), today announced nine grant awards of $1 million each for up to 5 years to support existing long-COVID clinics. The grants are also designed to expand access to care to patients suffering from long COVID, especially those in underserved groups and areas.
Robert Otto Valdez, PhD, AHRQ's director, said the grants have the potential to serve as a roadmap for developing better care models for clinics serving patients with long COVID. "We look forward to sharing actionable knowledge from AHRQ grantees with other healthcare providers to support high-quality care for vulnerable patients with Long COVID," he said.
For example, HHS said strategies include increasing access to in-person and virtual visits, adding dedicated care coordination, and integrating dedicated behavioral health staff and rehabilitation support programs.
The effort is part of the Biden administration's plan to accelerate research into long COVID and support patients who are battling the condition. HHS Secretary Xavier Becerra, JD, said, "Treatment of Long COVID is a major focus for HHS, and AHRQ is helping lead the way through grants to investigate best practices and get useful guidance to doctors, hospitals, and patients."
Global mpox spread continues at low levels, with hot spots in parts of Asia
Mpox activity continues at a low levels, with sustained transmission mainly occurring in the Southeast Asia and Western Pacific regions, the World Health Organization (WHO) said yesterday in a monthly update.
Since its last update in the middle of August, the WHO received reports of 1,131 new cases and 5 more related deaths, with a 1.3% rise in cases. Laos and Malaysia reported their first cases.
On September 8, China reported a batch of 501 new cases that were recorded in August, similar to what the country reported in July. The WHO added that China has reported cases from 25 of 31 provinces and that the epidemiologic picture fits with the global outbreak pattern of transmission mainly in men who have sex with men. The WHO also noted that Thailand has also reported a significant rise in mpox cases in recent months, with cases expanding beyond Bangkok.
In Africa, where mpox is regularly reported, cases declined during the reporting period, but the WHO said it's unclear if the drop is due to a decrease in cases or reporting delays.
In May amid an ongoing drop in cases, the WHO ended the public health emergency of international concern for mpox, and in August, its emergency committee issued standing recommendations to help countries battle the virus.
Only a fourth of recommended sepsis screening tools can reasonably predict sepsis, researchers say
Just one of four internationally recommended sepsis screening tools that emergency medical services (EMS) use can identify the life-threatening condition with any accuracy, according to research presented today at the European Emergency Medicine Congress in Barcelona, Spain.
A Universitätsmedizin Berlin–led team linked health insurance data from 221,429 patients seen by EMS in Germany in 2016 and 2017 with information on 110,419 patients from paramedics and emergency department (ED) doctors in 2016.
Sepsis, which occurs when the body mounts an outsized response to an infection, can lead to organ damage or death. Early identification and treatment of sepsis improves survival. The Society of Critical Care Medicine's Surviving Sepsis Campaign Guidelines 2021 recommend four screening tools.
NEWS-2 tool most predictive
The National Early Warning Score (NEWS-2) accurately predicted 72.2% of sepsis cases, followed by the Modified Early Warning Score (MEWS; 46.8%), the Systemic Inflammatory Response Syndrome (SIRS; 30.4%), and the quick Sequential Organ Failure Assessment (qSOFA; 24.0%). Those are sensitivity scores. For specificity, NEWS-2 correctly identified 81.4% of non-septic cases, compared with 88.4% for MEWS, 93.8% for SIRS, and 96.6% for qSOFA.
Piedmont said that positive NEWS-2 results should be flagged for potential sepsis. "If EMS insist on using the qSOFA, they should be aware that a positive qSOFA makes sepsis likely, but also, that a negative qSOFA cannot rule out sepsis conclusively," she said.
We found that paramedics never documented a suspicion of sepsis, and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases.
Of all EMS cases, 24.3% were predicted to have sepsis by at least one screening tool, but only 0.9% were identified by all four tools simultaneously.
"We found that paramedics never documented a suspicion of sepsis, and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases," lead researcher Silke Piedmont said in the European Society for Emergency Medicine news release.
Coauthor Wolfgang Bauer, MD, said that while standards for the identification and treatment of heart attacks and stroke have improved patients' odds of survival, sepsis standards have been neglected. Thus, although sepsis had a similar incidence (1.6%) as heart attacks (2.6%) and stroke (2.7%), more patients died of sepsis.
"Out of all cases with sepsis, 31.4% died within 30 days after being seen by emergency services, versus 13.4% and 11.8% respectively for heart attacks and stroke," he said.