COVID-19 Scan for Jul 18, 2022

News brief

Hospitalization for COVID-19 tied to 45% higher risk of heart failure

COVID-19 hospitalization is associated with a 45% greater risk of subsequent heart failure (HF), particularly for patients who are younger, White, or previously diagnosed as having heart disease, according to a US study published late last week in Nature Communications.

A University of Arkansas researcher led the study of 587,330 patients hospitalized from Mar 1, 2020, to Mar 31, 2022, using data from the National COVID Cohort Collaborative Study. Of those patients, 257,075 tested positive for COVID-19. The COVID-19 patients were older (51 vs 46 years), more likely to be male (49% vs 42%), and less likely to be White (61% vs 69%).

During a median of 367 days of follow-up, 10,979 patients developed HF, and 17,641 died of any cause. In adjusted analyses, COVID-19 was tied to a 45% higher risk of HF (hazard ratio, 1.45; 95% confidence interval, 1.39 to 1.51), with the greatest risk among younger and White patients and those with established cardiovascular disease.

Relative to non-COVID patients, infected patients had a higher rate of new diagnoses of HF (2.3% vs. 1.5%), death (3.3% vs. 2.6%), and composite death or new HF (5.2% vs. 4.0%) after hospital release.

The crude HF rate was higher for COVID-19 patients, at 2.55 vs 1.44 events per 100 person-years. The median time to new HF after hospital release was shorter among COVID patients (69 vs 84 days), although a similar proportion occurred within 30 days of release (33% vs 30%).

The authors said that COVID-linked heart damage and inflammation of the heart muscle (myocarditis) may have a role in the development of new HF. "A suspicion of HF should be triggered in patients who experience respiratory or cardiac symptoms following recovery from COVID-19 hospitalization," they wrote.
Jul 15 Nat Commun study

Survey: 42% of women report heavier bleeding after COVID vaccines

Results of a Web-based survey published late last week in Science Advances reveal that 42% of women with regular menstrual cycles had heavier bleeding after receipt of one or two doses of any approved COVID-19 vaccine.

After vaccination, 42% of women with regular menstrual cycles said they bled more heavily than usual, while 14.3% noted lighter or unchanged flow, and 44% reported no changes. And among respondents on long-acting, reversible contraceptives, 71% reported breakthrough bleeding, as did 39% taking gender-affirming hormones and 66% of postmenopausal women.

Abnormally heavy and breakthrough bleeding was significantly tied to older age, fever and fatigue after vaccination, previous pregnancy or delivery, and non-White ethnicity.

The researchers noted that some medical professionals had dismissed previous observations of abnormal bleeding after vaccination, leading to distrust of clinicians. The reports also fueled concerns from both vaccine-hesitant and anti-vaccine Americans, who conflated the possible association of short-term menstrual changes after COVID-19 vaccination with long-term fertility problems.

"Pundits, politicians, religious leaders, and wellness influencers worked the oft-used framing of protecting women to advise against the vaccine," they wrote. "Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine."

"We suspect that for most people the changes associated with COVID-19 vaccination are short-term, and we encourage anyone who is worried to contact their doctor for further care," said first author Katharine Lee, PhD, in a University of Illinois news release. "Getting the vaccine is one of the best ways to prevent getting very sick with COVID, and we know that having COVID itself can lead not only to changes in periods, but also hospitalization, long COVID, and death."
Jul 15 Sci Adv study
Jul 15 University of Illinois news release

Pre vaccines, teens and young adults had higher COVID-19 rates than older adults

A new study in JAMA Network Open shows a higher COVID-19 infection rate in adolescents and young adults compared with older adults before vaccines were available. The study is based on health department statistics from 19 states, and it contradicts previous studies from Europe and Asia that showed older adults were more at risk of contracting the virus during the early months of the pandemic.

The study used health statistics from 19 states that experienced a surge of virus activity in the fall of 2020, defined as an increase of at least 75% from a plateau 2 to 3 months earlier that lasted at least 1 month. The states also had to classify cases in age brackets.

The 19 states were Alabama, Alaska, Colorado, Florida, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, and Wisconsin.

In 16 of the 19 states, the incidence rate of COVID-19 was significantly higher in adolescents and youth than it was in older adults, the authors said. The incident rate ration (IRR) reached 1 or more in these 16 states.

Only three states—South Dakota, Michigan, and Pennsylvania—saw higher IRR in adults. The authors linked these increased rates to attendance at political rallies and the Sturgis motorcycle rallies, large unmasked events.

"Possible reasons for our findings are that adolescents had more contacts than adults; and that older adults, feeling vulnerable, were more likely to adhere to masking and/or social distancing " the authors concluded.
Jul 15 JAMA Netw Open study

News Scan for Jul 18, 2022

News brief

International travel linked to spread of multidrug-resistant STIs

International travel may play a critical role in the spread of multidrug-resistant (MDR) sexually transmitted infections (STIs), according to a study published late last week in Travel Medicine and Infectious Disease.

In a systematic review and meta-analysis of studies on gonococcal infection, antibiotic resistance, and international travel that were published from 2010 to 2021, a team of Spanish researchers found that 16 of 18 studies described a probable link between international travel and transmission of MDR Neisseria gonorrhoeae from the country of travel to the country of return, as the index cases reported unprotected sexual intercourse at their place of destination. Travelers mainly visited Southeast Asian countries (66.7%) and returned to the United Kingdom (38.9%).

Half of the studies (9) reported N gonorrhoeae strains with resistance to ciprofloxacin, while 7 described cephalosporin resistant and 4 described decreased sensitivity to penicillin and azithromycin. The most frequently prescribed antibiotic for treatment was ceftriaxone.

The meta-analysis also found that men in their 30s are more likely to be infected by an MDR STI.

"As no vaccinations are currently available for these infections, sexual education should therefore play an important role in the routine pre-travel consultation," the study authors concluded. "Returned travelers who present with gonococcal infection should be screened for antibiotic resistance to avoid transmitting drug-resistant pathogens to other worldwide locations."
Jul 16 Travel Med Infect Dis abstract

Ghana declares Marburg fever outbreak

After tests confirmed two Marburg virus cases from Ghana, the country declared an outbreak, its first involving the virus, which causes a hemorrhagic illness similar to Ebola.

In a statement, the World Health Organization (WHO) African regional office said the Pasteur Institute in Senegal confirmed the preliminary findings from Ghana. The patients are two unrelated men who sought care at the same hospital in Ashanti region, both of whom died from their infections. Ashanti region is located in the southern part of the country.

The first patient is a 26-year-old man who was hospitalized on Jun 26 and died the next day. The second is a 51-year-old man who was hospitalized on Jun 28 and died the same day. So far, 90 contacts—some of them health workers—have been identified and are being monitored.

Ghana's Marburg outbreak is only the second to occur in West Africa. The other occurred in Guinea in 2021, resulting in one confirmed case. The virus is transmitted from fruit bats to people and can spread among humans through direct contact with body fluids.
Jul 17 WHO African regional office statement

Unexplained illness cluster in Tanzania linked to leptospirosis

An unexplained cluster of hemorrhagic illnesses in Tanzania has been identified as leptospirosis, the country's health minister said today at a briefing, according to The Citizen, an Africa-based news outlet.

Three deaths were reported earlier this month, and nosebleed symptoms prompted suspicion about a potential hemorrhagic fever outbreak.

At today's briefing, health minister Ummy Mwalimu said more than 20 cases have been reported, 3 of them fatal. Two people are hospitalized. The outbreak is centered in Lindi region in the country's southeast.

The disease—caused by Leptospira interrogans—spreads from animals to humans through contact with the urine of infected animals. Mwalimu said it's rare for the bacterium to spread from person to person.
Jul 18 Citizen story
Jul 14 CIDRAP News scan