COVID-19 Scan for Apr 26, 2022

News brief

Fourth COVID vaccine dose tied to 78% lower risk of death in older Israelis

Israelis aged 60 and older given a fourth dose of the Pfizer/BioNTech COVID-19 vaccine amid the Omicron surge had a 64% lower risk of hospitalization and 78% lower risk of death than those who received three doses, suggests an observational study published yesterday in Nature Medicine.

Clalit Health Services researchers compared the outcomes of 328,597 patients who received a fourth COVID-19 vaccine dose with those of 234,868 patients who received three doses. Israelis 60 and older who had received a third dose at least 4 months before became eligible for a fourth dose on Jan 3, 2022, and study follow-up began 1 week later. Average patient age was 73.0 years, and 53% were women.

In the fourth-dose group, 270 patients were hospitalized, compared with 550 in the three-dose group (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.31 to 0.43). Ninety-two fourth-dose patients died, as did 232 third-dose recipients (adjusted HR, 0.22; 95% CI, 0.17 to 0.28).

Risk factors for death included age 70 to 79 (HR, 2.24) and 80 to 100 (HR, 9.95), male sex (HR, 1.59), chronic heart failure (HR, 4.11), chronic obstructive pulmonary disease (COPD) (HR, 1.82), diabetes (HR, 2.06), and stroke (HR, 1.84).

Risk factors for hospitalization included age 70 to 79 (HR, 1.82) and 80 to 100 (HR, 4.04), male sex (HR, 1.53), chronic heart failure (HR, 2.17), chronic kidney failure (HR, 2.27), COPD (HR, 2.24), diabetes (HR, 1.43), high blood pressure (HR, 1.39), ischemic heart disease (HR, 1.21), and stroke (HR, 1.43).

"Although this study is observational in nature, we believe that its substantial findings and the observed potential for avoiding the most severe COVID-19 outcomes could assist decision-makers in assessing the benefit of providing the second-booster to targeted populations," the researchers wrote. "Studies with long-term follow-up to determine the durability of the second-booster effectiveness against severe disease and safety are warranted."
Apr 25 Nat Med study

When hospitalized, Omicron patients require similar care to Delta patients

Though they need hospital care much less often, patients hospitalized with the Omicron SARS-CoV-2 variant require similar levels of respiratory support and intensive care unit (ICU) treatment as those with the Delta variant, according to a Johns Hopkins study published in the May issue of eBioMedicine.

The study involved 1,119 Omicron and 908 Delta patients diagnosed from Nov 22 to Dec 31, 2021, in the Washington, DC, area. The researchers found that the Omicron patients were 67% less likely to require hospitalization, 62% less likely to need ICU care, and 74% less likely to die than their Delta-infected counterparts.

Once in the hospital, however, patients with Omicron had a similar need for supplemental oxygen and ICU care as hospitalized Delta patients. Among Omicron patients, 67.6% required supplemental oxygen, and 17.6% were taken to an ICU. For Delta, 73% needed supplemental oxygen, and 25.4% required ICU-level care.

The researchers found no significant differences in viral loads between the two groups, regardless of vaccination status.

"It's true that patients with omicron were significantly less likely to be admitted to the hospital than patients with delta," said senior author Heba Mostafa, MBBCh, PhD, in a Johns Hopkins news release. "But omicron patients who did need hospitalization faced a risk of severe disease comparable to those hospitalized with delta. For many people, it is not a mild infection at all."
May EBioMedicine study
Apr 25 Johns Hopkins news release

News Scan for Apr 26, 2022

News brief

DRC reports second fatal Ebola case in latest outbreak

The Democratic Republic of the Congo (DRC) has confirmed a second case in its latest Ebola outbreak in Equateur province, a close contact of the index patient. The newest patient has also died from her infection.

On Twitter, the World Health Organization (WHO) African regional office said the 25-year-old woman started experiencing symptoms 12 days before she died. She was the sister-in-law of the index patient and was considered one of the man's high-risk contacts. Health officials are tracing the contacts of both patients, and so far, 145 have been identified and are under monitoring.

The outbreak, the DRC's 14th and third since 2018 in Equateur province, is centered near Mbandaka. Genetic analysis suggests the outbreak is the result of a new spillover from an animal reservoir.
Apr 26 WHO African regional office tweet
Apr 25 CIDRAP News story

China reports world's first human H3N8 avian flu infection

China's National Health Commission (NHC) today announced the first known human infection from H3N8 avian influenza, a strain known to have infected different animals before, but not people.

The patient is a 4-year-old boy from Zhumadian City in Henan province, located in the central part of the country, according to the statement in Chinese, which was first translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

His symptoms, including a fever, began in Apr 5, and he was admitted to the hospital 5 days later after his condition worsened. On Apr 24, the Chinese Center for Disease Control conducted tests on the boy's specimens, which revealed H3N8.

An investigation found that there were chickens and wild ducks around the boy's home. Provincial officials who followed up on the case found no related illnesses in the child's contacts.

The NHC said an initial assessment suggests that the H3N8 has an avian origin and doesn't have the ability to efficiently infect humans. It added that H3N8 has been detected before in horses, dogs, birds, and seals in different parts of the world. The agency said the case likely represents occasional bird-to-human transmission and that the risk of wider transmission is low.
Apr 26 NHC statement
Apr 26 AFD post

More kids' hepatitis cases reported in US and abroad

Several more unexplained hepatitis cases in young children have been reported, including three in Illinois and more in the United Kingdom. Also, media reports note possible cases in Japan and Romania.

In the United States, the Illinois Department of Public Health (IDPH) reported three potential cases of severe hepatitis in children, two in suburban Chicago and one in the western part of the state. One of the patients required a liver transplant.

Overseas, the UK Health Security Agency (HSA) posted a technical update today, which notes 3 more cases, raising the country's total to 111. The HSA said an adenovirus connection is still being considered, with data showing a marked increase in adenovirus circulation in children, especially in those ages 1 to 4.

In related developments elsewhere, Japan and Romania reported possible cases, according to separate media reports.
Apr 25 IDPH statement
Apr 25 UK HSA technical update
Apr 25 Jiji Press story on Japanese case
Apr 26 Valahia News story on Romanian case

Five states report more avian flu outbreaks

Five states, four of them in the Midwest, reported more highly pathogenic avian flu outbreaks in poultry flocks, as federal officials reported 94 more detections in wild birds from surveillance activities.

Minnesota, one of the hardest-hit states, reported six more outbreaks, five involving turkey farms and one in backyard birds, according to the Minnesota Board of Animal Health (MBAH). So far, Minnesota outbreaks have led to the loss of 2.7 million birds.

Elsewhere in the Midwest, Indiana reported another sample presumptively positive for the H5N1 strain. The detection involves a hobby flock in Johnson County, the state's ninth outbreak, according to an email from the Indiana Board of Animal Health. The flock has 41 birds, which includes chickens, ducks, and peafowl.

Also, Iowa reported its 18th outbreak, which affected backyard birds in Kossuth County, according to the Iowa Department of Agriculture and Land Stewardship (IDALS). And Michigan reported its seventh outbreak, which struck backyard birds in Menominee County, according to an update from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

Outside of the Midwest, Utah reported an outbreak—its second—at a layer farm in Cache County that houses 1.4 million birds, according to APHIS.

Nationally, the outbreaks have hit poultry in 29 states and so far have led to the loss of more than 33 million birds, APHIS said.

Meanwhile, surveillance in wild birds continues to turn up more highly pathogenic H5 positives, according to APHIS, which added reported of 95 more, raising the total to 857. Most are from the Midwest, including North Dakota, Minnesota, Wisconsin, South Dakota, and Illinois. However, a few detections were reported in other parts of the country, including New Hampshire, Ohio, and Montana.
MBAH update
Apr 24 IDALS statement
USDA APHIS poultry outbreak updates
USDA APHIS wild bird avian flu updates