WHO: Recent severe H5N1 avian flu cases in China, Vietnam linked to current clade

News brief

In a new risk assessment, the World Health Organization (WHO) said two recent severe H5N1 avian flu infections reported from China and Vietnam are linked to the clade, the strain currently circulating in multiple regions that has been linked to a few mild infections in Europe and the United States. The risk assessment's publication was first reported by Avian Flu Diary, an infectious disease news blog.

The case from Vietnam was initially reported in October in a 5-year-old girl from Phu Tho province who was seriously ill. It marked the country's first human H5N1 case in 8 years, but it wasn't clear if the new case involved the earlier clade or the more recent one. The case from China, reported in late November, involved a woman from Guangxi province who died from her infection.

Both patients had been exposed sick poultry. The Vietnamese girl had reportedly eaten the meat of sick chickens and ducks, and the Chinese woman had been exposed to live poultry before her symptoms began.

The cases lift the number of human infections from H5N1 clade to six. The others were from the United Kingdom, the United States, and Spain, all of which were mild and involved people who had extensive contact with poultry.

The WHO said virus sequences, when available, showed no markers for adaptation to mammals or resistance to neuraminidase inhibitors. It warned that the virus continues to diversify and bears close watching. Though several mammals have been infected, the virus doesn't seem to be transmitting among mammals.

So far, the risk to humans remains low, and no sustained human-to-human transmission has been reported, the WHO said.

More outbreaks in poultry in multiple world regions

In the United States, four states reported more outbreaks in poultry, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). California reported an outbreak at a game bird farm in Glenn County, and Tennessee reported an outbreak at a backyard location producing eggs in Weakley County.

In Africa, Niger reported H5N1 in village birds, and in Europe, more outbreaks in poultry were reported from Poland, Spain, and Denmark, according to the latest notifications from the World Organization for Animal Health (WOAH).

COVID vaccine messages led to more uptake in ED patients

News brief

A cluster-randomized clinical trial finds that educational messaging significantly boosted COVID-19 vaccine acceptance and uptake among 496 unvaccinated patients at US emergency departments (EDs) over 8 months.

In the study, published yesterday in JAMA Internal Medicine, a team led by University of California at San Francisco researchers showed a 4-minute video, gave a flyer, and had ED physicians or nurses deliver a scripted message on COVID-19 vaccination to patients waiting to be seen at seven EDs in four US cities from Dec 6, 2021, to Jul 28, 2022. The cities were Durham, North Carolina; Philadelphia; San Francisco; and Seattle.

The team developed the materials after conducting qualitative interviews with 65 vaccine-hesitant ED patients to determine the reasons behind their hesitancy and other barriers to vaccination, and to identify trusted messengers and messages that might increase vaccine uptake.

Of the 496 participants (221 during intervention weeks and 275 during control weeks with no messaging), the median age was 39 years, 41.3% were female, 38.9% were Black, 19.6% were Hispanic, and 44.0% didn't have a primary care physician. The patients were from traditionally underserved groups with disproportionately high rates of accessing primary healthcare in EDs and low vaccine uptake (eg, Black and Latino people, immigrants, those with no housing or insurance).

8% to 12% higher uptake

Relative to control participants, more intervention patients said they would accept a vaccine dose in the ED (25.8% vs 12.0%). More intervention patients also told follow-up telephone interviewers that they received a vaccine within 30 days after their ED visit (20.0% vs 8.7%).

The intervention group had larger outcome effect sizes than controls in terms of participants who didn't have a primary care physician (acceptance, 37.6% vs 13.7%; uptake, 30.7% vs 9.4%) and Hispanic patients (acceptance, 44.2% vs 10.4%; uptake, 42.3% vs 8.3%).

"If implemented nationally in EDs, an 8% to 12% increase in vaccine uptake and acceptance could lead to the delivery of tens of thousands of COVID-19 vaccines to people who would not otherwise get vaccinated," the study authors wrote.

Measles outbreak continues in Ohio

News brief

The Columbus, Ohio, area measles outbreak has increased to 82 cases, with 32 hospitalized. Of the 82 patients, 74 were unvaccinated. The others had unknown status or were partly vaccinated.

Local news reports say 24 kids have required hospitalization.

So far, 36 children ages 1 or 2 years have been infected, followed by 23 infants under 1, 18 kids ages 3 to 5, and 5 children ages 6 to 17 years. Four patients have unknown vaccine status, and four were partially vaccinated with only one dose of the measles, mumps, rubella (MMR) vaccine.

Per the Centers for Disease Control and Prevention, "Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age."

One dose of MMR vaccine is 93% effective against measles, and two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.

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