COVID-19 Scan for Aug 29, 2022

News brief

Even young kids can accurately self-collect nasal swabs for COVID-19 tests

Children aged 4 to 14 years can accurately self-collect nasal swabs for COVID-19 testing after viewing simple instructions, suggests a study late last week in JAMA.

Emory University researchers led the study of 197 symptomatic children aged 4 to 14 years who self-collected nasal swabs for COVID-19 polymerase chain reaction (PCR) testing after being shown a 90-second video and given a handout with written and pictorial instructions. The swabs were tested along with those collected by a healthcare worker (HCW) to determine result agreement.

The children were recruited from the Children's Healthcare of Atlanta from July to August 2021. Median patient age was 9 years, 55.7% were boys, and 44% tested positive for COVID-19 by both methods of specimen collection.

Self-collected swabs with positive COVID-19 test results agreed with those from an HCW 97.8% of the time (95% confidence interval [CI], 94.7% to 100.0%), while negative results had 98.1% (95% CI, 95.6% to 100.0%) agreement. SARS-CoV-2 viral loads didn't differ significantly.

Children aged 8 and younger more often required help, such as further instruction, to accurately swab their nose (21.8% vs 6.1% for older children), but viral detection didn't differ between the two groups.

The researchers said the results could inform school testing policies. "Pediatric self-swabbing will support expanded testing access and should make it even easier to test school age populations with fewer resources," coauthor Tim Stenzel, MD, PhD, of the US Food and Drug Administration (FDA), said in a National Institute of Biomedical Imaging & Bioengineering (NIBIB) news release.

In a related editorial, Ilan Youngster, MD, of Shamir Medical Center in Israel, cautioned that further research in broader populations (eg, asymptomatic children, those infected with the newer SARS-CoV-2 variants) is required. "If the preliminary results of this study are replicated in other studies, this simple intervention could be applied in a variety of settings in the community for different respiratory pathogens, without specialized personnel," he wrote.
Aug 26 JAMA study and editorial
Aug 26 NIBIB news release

Half of kids with Omicron test positive at 7 days—beyond CDC guidance

Almost half of children infected with the original Omicron COVID-19 strain still tested positive 7 days after they first had symptoms, calling into question guidance from the US Centers for Disease Control and Prevention (CDC) on how long to isolate, according to a small study late last week in Clinical Infectious Diseases.

University of Florida researchers screened 65 sequential nasal swab samples from 31 children who no longer had symptoms and were 0 to 16 years old. Swabs were collected starting at day 5 after symptoms first appeared, the point at which they would be clear to leave isolation, according to CDC guidelines updated in January. The children tested positive for SARS-CoV-2 Omicron BA.1, and the swabs were collected from Dec 20, 2020, through Feb 21, 2022.

Of the 31 children, 15 (48%) still tested positive by day 7 by rapid antigen test. The investigators also performed virus culture on the first 15 samples collected and found 100% agreement with the rapid antigen results, indicating the children were likely still infectious after their positive antigen tests.

The study authors conclude, "In this study, close to half of infected children remained positive for SARS-CoV-2 (and likely were infectious) for at least two days after they would have returned to school under the January 14, 2022, CDC guidelines."

They add, "Consideration should be given to lengthening the recommendation for five days of isolation before return to school, potentially in combination with requirements for a negative rapid test result."
Aug 27 Clin Infect Dis abstract

US COVID indicators decline; last call for free rapid tests from feds

In the lead-up to the Labor Day holiday weekend, most US COVID-19 markers continued to decline last week, with cases falling 6% compared with the previous week and hospitalizations down 3%, according to the Washington Post tracker. However, deaths—often a lagging indicator—were up 3%. Currently, the 7-day average for new daily cases is 87,533, with the daily average of deaths at 490.

In other US developments, the FDA last week provided clinicians with more guidance on evaluating potential drug interactions for prescribing Paxlovid.

Also, the federal government said it is winding down its free mail-order distribution of rapid COVID-19 tests on Sep 2, due to a lack of funding by Congress to replenish the national stockpile. For a few more days, a third round of tests is available by mail to those who haven't already received their quota.

In international developments, the European Centre for Disease Prevention and Control (ECDC) posted five plausible scenarios on how the COVID-19 pandemic might play out over the next decade, a tool to help with pandemic planning. It added that the scenarios are not mutually exclusive and that the situation could transition from one to the next. The scenarios range from a diminished threat to long, barely manageable winters to a new pandemic.
Washington Post COVID-19 tracker
FDA updated Paxlovid prescribing guidance
Federal government free rapid test site
Aug 29 ECDC long-term COVID scenarios

News Scan for Aug 29, 2022

News brief

Algorithm may aid appropriate antibiotic prescribing for kids with diarrhea

A randomized trial of children with diarrhea in two low-income countries found that use of an algorithm to predict the likelihood of viral etiology resulted in reduced antibiotic use in children who had a higher likelihood of viral illness, researchers reported today in JAMA Pediatrics.

To determine whether the diarrheal etiology prediction (DEP) algorithm improves prescribing in children with acute diarrhea, an international team of researchers conducted a randomized crossover study at 7 government hospitals in Bangladesh (3 sites) and Mali (4 sites). Physicians enrolled in the study were randomized into an intervention arm in which the DEP, which calculates the probability of viral etiology of diarrhea based on patient-specific and location-specific features, was incorporated into smartphone-based electronic clinical decision support tool (eCDS with the DEP), and a control arm (eCDS without DEP) for 4 weeks, followed by a 1-week washout period and 4-week crossover period. The primary outcome was the proportion of children who received an antibiotic.

A total of 30 physicians and 941 patients (57.1% male; median age, 12 months) were enrolled. Overall, 309 (69.8%) children in the DEP arm were prescribed antibiotics, compared with 381 (76.5%) in the control arm.

There was no evidence of a statistically significant difference in the proportion of children prescribed antibiotics by physicians using the DEP (risk difference [RD], −4.2%; 95% confidence interval [CI], −10.7% to 1.0%). A post hoc analysis, however, found that, in children who had a higher predicted probability of viral-only diarrhea, there was a small but statistically significant difference in risk of antibiotic prescription between the DEP and control arms (RD, −0.056; 95% CI, −0.128 to −0.01). No known adverse effects of the DEP were detected 10 days after discharge.

The study authors say the post hoc analysis suggests that providing physicians with an estimated probability of the cause of diarrheal illness can improve appropriateness of antibiotic use, particularly in low-resource settings where antibiotic treatment for diarrhea rarely follows international guidelines.

"These findings represent a technical and behavioral proof-of-concept that a probability-based eCDS in resource-limited settings can impact antibiotic use in pediatric patients," they wrote.
Aug 29 JAMA Pediatr study

High-path avian flu hits more poultry in 3 states, including 2 farms

Three states reported more highly pathogenic avian influenza outbreaks in poultry, including California, where the virus struck two commercial flocks, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

In California, outbreaks occurred at a turkey farm housing 161,000 birds in Tuolumne County, located in the central part of the state, and a broiler breeding farm that has 34,800 birds in Fresno County. Also, the APHIS recently reported an event involving a backyard flock in Contra Costa County.

Elsewhere, APHIS reported more outbreaks in backyard birds in Utah and Washington. Utah's outbreak occurred in Webster County at a location that had 20 birds. Washington reported two similar outbreaks, one in Cowlitz County and the other in Pierce County.

So far, the outbreaks involving the Eurasian H5N1 strain have led to the loss of 40.3 million birds across 39 states.

Meanwhile, outbreaks in wild birds have also continued, and APHIS recently reported 12 more detections, raising the total to 2,116. Most of the new detections were waterfowl found dead in Oregon.
USDA APHIS poultry outbreak updates
USDA APHIS wild bird detection updates

In international developments, Russia reported another H5N1 outbreak in village geese and poultry in Chelyabinsk oblast, located in the west central part of the country near the Ural Mountains. According to the World Organization for Animal Health (WOAH), the outbreak began on Aug 17, killing 87 of 2,023 birds.
Aug 29 WOAH report