COVID-19 Scan for Jan 25, 2022

News brief

12% to 15% of US adults report serious psychological distress amid COVID

Among 1,068 US adults surveyed about their mental health amid the COVID-19 pandemic, 12% to 15% reported serious psychological distress that persisted throughout the study period, mostly among young adults, low-income respondents, and Hispanic participants.

The data were published yesterday in JAMA Network Open.

A team led by Johns Hopkins University researchers fielded the survey in four waves: Apr 7 to 13, Jul 7 to 13, and Nov 11 to 30, 2020, and Jul 26 to Aug 16, 2021, all times of increasing COVID-19 cases. Participants were drawn from the probability-based AmeriSpeak Panel of NORC at the University of Chicago. Average respondent age was 49 years, 48% were men, 18% were Hispanic, and 13% were Black.

The team measured psychological distress with the 6-item Kessler Psychological Distress Scale, in which a score of 13 or higher on a scale of 0 to 24 indicates severe distress. Participants who reported any psychological symptoms were asked how often they saw a health professional for treatment.

Of the 1,068 sample members, 129 (12%) to 157 (15%) reported serious psychological distress, with no statistically significant differences in prevalence over all survey waves. For comparison, before the emergence of COVID-19 in 2020, the psychological distress was consistently 3% to 4%.

During all four survey waves, adults aged 18 to 29 years, those with an annual household income less than $35,000, and Hispanic participants reported the highest prevalence.

Of the 242 respondents (22.7%) with serious distress during at least one survey period, 125 (51.7%) saw a health professional for their symptoms. Among the 59 (5.5%) who reported severe distress throughout the study period, 47 (80.0%) visited a health professional.

"Future research should consider whether and how pandemic-related distress translates into long-term shifts in population mental health burden and service needs," the study authors concluded.
Jan 24 JAMA Netw Open research letter

Myocarditis rare but greater than expected after COVID mRNA vaccination

Seven days after receipt of a COVID-19 mRNA vaccine, rates of myocarditis were greater than expected and were highest after the second vaccine dose among males 12 to 24 years old—although the condition was still exceedingly rare, finds a descriptive US study today in JAMA.

Myocarditis is inflammation of the heart muscle, a condition that peaks in incidence in infancy and adolescence or young adulthood. Some patients require no treatment, yet others die or experience severe heart failure necessitating heart transplant.

The study, led by Centers for Disease Control and Prevention (CDC) researchers, studied outcomes among 192,405,448 US residents who received 354,100,845 mRNA COVID-19 vaccine doses from December 2020 to August 2021. The researchers calculated expected rates of myocarditis by age and sex using 2017-2019 claims data.

Among the 192,405,448 vaccinees, 1,991 cases of myocarditis (0.00004%) were reported to the Vaccine Adverse Event Reporting System (VAERS), with 1,626 (0.000008%) meeting the case definition. Of all patients with myocarditis, median age was 21 years, 82% with a reported sex were male, and median time to symptom onset was 2 days.

Myocarditis rates were highest after the second vaccine dose in males 12 to 15 years old (70.7 per million doses of Pfizer/BioNTech vaccine), 16 to 17 years (105.9 per million Pfizer doses), and 18 to 24 years (52.4 and 56.3 per million doses of Pfizer vaccine and Moderna vaccine, respectively).

Although difficult to estimate, the prevalence of myocarditis in the US general population may range from 0.00001% to 0.0001%.

Among patients younger than 30 years with detailed clinical information, 826 had myocarditis. Of these patients, 792 of 809 (98%) had increased troponin concentrations (indicating heart injury), 569 of 794 (72%) had abnormal electrocardiogram results, and 223 of 312 (72%) had abnormal results on cardiac magnetic resonance imaging.

About 96% (784 of 813) patients were hospitalized, and myocarditis symptoms resolved in 87% (577/661) of them by the time of hospital release. The most widely used treatment consisted of nonsteroidal anti-inflammatory drugs (589/676,87%).

The researchers said that myocarditis after COVID-19 mRNA vaccination is a rare but potentially serious event. "This risk should be considered in the context of the benefits of COVID-19 vaccination," they wrote.
Jan 25 JAMA study

News Scan for Jan 25, 2022

News brief

Study suggests shorter IV antibiotic durations for young infants with UTIs

A review and meta-analysis of studies on urinary tract infections (UTIs) in young infants suggests shorter intravenous (IV) antibiotic courses, with an early switch to oral antibiotics, should be considered, Australian researchers reported yesterday in Pediatrics.

While international guidelines recommend admitting all infants 90 days or younger with a UTI to the hospital for initial IV antibiotic therapy, there is no consensus on the optimal time for when young infants can be safely switched from IV to oral therapy, and considerable variation in IV antibiotic duration for UTIs in this age-group remains. To determine if a shorter IV course may be appropriate for young infants with UTIs, researchers screened 10,181 records and identified 18 studies involving 16,615 young infants that met the inclusion criteria.

The largest two studies on bacteremic UTI found no difference in the rates of 30-day recurrence or 30-day all-cause hospitalization between young infants who received 7 days or less of IV antibiotics and those who received more than 7 days.

For infants with non-bacteremic UTIs, there was no significant difference in the 30-day adjusted recurrence rate between those treated with 3 days or less of IV antibiotics and those treated with more than 3 days. Three studies used oral antibiotics alone and reported good outcomes, although only 85 infants in those studies were 90 days or younger.

"These findings have important implications for clinical practice, because shorter IV antibiotic courses with an early switch to oral therapy can improve the quality of life of children and their families, reduce the length of hospital stay, the risk of nosocomial infections, and health care costs," the review authors wrote.

The authors note that the recommendations are only for young infants when meningitis has been excluded and who have no features of sepsis.
Jan 24 Pediatrics abstract

H9N2 avian flu sickens 1 more in China

China reported one more human H9N2 avian flu case, which involves a 5-year-old boy from Anhui province, Hong Kong's Centre for Health Protection (CHP) said in its latest avian influenza update.

The boy's symptoms began on Nov 13, 2021. The report didn't note the exposure source or clinical details.

China reported a spurt of 11 H9N2 infections in the final months of 2021. Illnesses involving the subtype are rare, most commonly affecting children. Infections are typically mild, but in November, China reported a fatal infection in an adult.

The virus is common in Asian poultry, and many cases involve close contact with poultry or poultry environments.
Jan 25 Hong Kong CHP avian flu report

H5N3 avian flu detected in German waterfowl

Animal health officials in Germany recently reported a highly pathogenic H5N3 avian flu event involving a wild bird found in Mecklenburg-Vorpommern state, according to a notification to the World Organisation for Animal Health (OIE).

The outbreak began on Dec 22. The water bird that tested positive was destroyed to curb the spread of the virus. The event marks Germany's first H5N3 detection since May 2021. Mecklenburg-Vorpommern state is in the country's northeast.

In November, the OIE urged increased avian flu surveillance owing to expanding poultry outbreaks and detections in wild birds. It said an unprecedented number of subtypes are circulating, including H5N1, H5N3, H5N4, H5N5, H5N6, and H5N8. Human illnesses involving the strains are very rare but can sometimes occur in people who have contact with poultry.
Jan 24 OIE report on H5N3 in Germany