COVID-19 Scan for Jul 23, 2021

News brief

Side effects after Pfizer COVID vaccine more common after COVID-19

Patients with a history of COVID-19 were more likely to have side effects after their first dose of the Pfizer/BioNTech COVID-19 vaccine than those who were never infected, according to a Vaccine study yesterday.

The researchers conducted a prospective observational study consisting of 311 healthcare workers from a university tertiary care hospital in France. From Jan 27 to Feb 5, they self-reported demographics and symptoms 21 to 28 days after their first vaccination and before their second.

The mean age was 55.4 years, and 60% of respondents were women. Twenty (6.4%) had a history of COVID-19, and 19 were symptomatic, but none were hospitalized. The mean duration between COVID-19 infection and their first vaccine dose was 10.3 months.

About 74% of participants (229) had at least one side effect, affecting 95% of those with prior COVID-19 and 70% of coronavirus-naive recipients. Systemic reactions, which 37% experienced, were most commonly fatigue (18%), headache (14%), and muscle pain (20%). Of the 66% who had a local reaction, site injection pain was more frequent than erythema (skin redness; 63% vs 8%). No side effects required additional medical attention.

"Vaccine recipients with prior COVID 19 infection experienced systemic side effects with a significantly higher frequency than naive patients," write the researchers. "However, symptom intensity was not different between the 2 groups, [except] for headache." Three of six people with headaches who previously had COVID-19 had severe headaches, compared with 3 of 37 people without prior infection.
Jul 22 Vaccine study


Malnutrition linked to worse COVID-19 outcomes

Adults and children with COVID-19 and a history of malnutrition may be more likely to die of their infections or need mechanical ventilation, according to a study yesterday in Scientific Reports.

The researchers looked at 8,604 children (mean age, 6 years) and 94,495 adults (mean age, 53 years) hospitalized with COVID-19 across 56 US hospitals from March to June 2020 and compared those with a malnutrition history from 2015 to 2019 with those without. Twenty-one children and 4,706 adults died.

Children with malnutrition made up 7.5% of severe pediatric COVID-19 cases (39 of 520) and 1.5% of mild pediatric COVID-19 cases (125 of 7,959). As for adults, those with malnutrition made up 4% of severe COVID-19 cases (453 of 11,423), and 1.8% of mild cases (1,557 of 81,515).

Overall, 1.9% of pediatric patients (164) and 2.1% of adult patients (2,010) in the cohort had a history of malnutrition.

Data indicated that children older than 5 and adults ages 18 to 78 with previous malnutrition were more likely to have severe COVID-19 than the same age-groups without. While children younger than 5 and those older than 79 had higher odds of severe COVID-19 if they were not malnourished, the researchers say this could be due to a lack of medical data and a general high risk for COVID-19 infection, respectively.

"Emphasis has been placed very early into the pandemic on the impact of age and comorbidities on the risk of severe COVID-19 and obesity has been the focus of the nutrition conversation," the researchers write.

"This study established that the long-term effect of (or preexisting) malnutrition is also a critically important piece of the puzzle. While the COVID-19 pandemic may lead to increased incidence of malnutrition, malnourished patients or patients at risk of malnutrition are also at risk of suffering more severe forms of the disease."
Jul 22 Sci Rep study

News Scan for Jul 23, 2021

News brief

India reports its first human avian flu case

In the wake of media reports from India that said the country has detected its first human avian flu case, the health ministry today confirmed that H5 was found in a child who had underlying health conditions and died on Jul 12. The ministry report in Hindi was translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

The report said the child was first treated in June at the All India Institute of Medical Science (AIIMS) in New Delhi, where the patient's condition worsened. Tests on respiratory samples were positive for both influenza A and B, and subtyping for influenza A was inconclusive. Follow-up testing at the National Institute of Virology revealed both H5 and influenza B, and genetic sequencing and virus isolation are under way.

Indian media reports, citing officials at AIIMS, said the patient was an 11-year-old boy who died from leukemia complications.

Investigators are following the child's contacts, including those who work in healthcare, and so far none have shown symptoms. No suspected cases of avian flu in birds have been reported in the area where the child was sick, but enhanced surveillance is taking place.
Jul 23 AFD post
Jul 23 Times of India story


Global flu activity stays low, dominated by influenza B

In a global flu update covering the last week of June and first week of July, virus levels in both hemispheres stayed at interseasonal levels, with influenza B dominating among the few respiratory samples that have tested positive, the World Health Organization (WHO) said in its latest global flu update.

Sporadic activity was reported from a few countries, including West and East Africa and South Asia, including India, Nepal, and Pakistan. In Southeast Asia, the Philippines reported a few cases.

Of respiratory samples that tested positive for flu at national flu labs, 77.3% were influenza B, with all but two samples belonging to the Victoria lineage. Of subtyped influenza A samples, 58.2% were 2009 H1N1 and 40.8% were H3N2.

The WHO included its usual caveats that flu activity and detection may be influenced by COVID-19 public health measures and changes in surveillance.
Jul 21 WHO global flu update


Six African countries report more vaccine-derived polio cases

Six African countries reported new polio cases this week, all involving vaccine-derived strains, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update. Ethiopia, Liberia, Nigeria, Senegal, and South Sudan all reported circulating vaccine-derived poliovirus type 2 (cVDPV2), while Madagascar reported cVDPV1.

Ethiopia reported 10 more cases, 8 in Oromya and 2 in Amhara, which are counted with its 2020 total, now at 36. Liberia reported 1 more case, involving a patient form Nimba county, putting its overall cVDPV2 total at 3. Nigeria reported 9 more cases in 5 states, raising its 2021 total to 31.

In Senegal, officials reported a case in Thies, putting its total for the year at 12. Also, South Sudan reported 1 more case, which affected a person from West Nile district, bringing its 2021 number to 9.

And finally, Madagascar added two more cVDPV1 cases, raising its total for the year to six.
Jul 22 GPEI update
GPEI list of cVDPV cases

ASP Scan (Weekly) for Jul 23, 2021

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Funds for new solutions for infectious diseases, antimicrobial resistance

Originally published by CIDRAP News Jul 22

The London School and Hygiene & Tropical Medicine (LSHTM) announced yesterday that a knowledge exchange program led by the Royal Veterinary College, known as Bloomsbury SET, has received a total of £1.9 million ($2.6 million) from Research England for a 1-year project. The effort will engage businesses to deliver vaccines, diagnostics, and treatments to battle infectious diseases and antimicrobial resistance in animals and people.

One of the goals of the program—called the Impact Connector—is to build support for commercializing research across partner groups and collaborate across geographic regions. Components will include product development workshops, skills programs to commercialize research, and activities to support connections between groups.

The program will also provide small grants to encourage new collaborations.

Hannah Whiteman, BSc Msc, PhD, head of strategic research at LSHTM, said, "The programme will empower our innovators across career stages with training, funding, and opportunities to forge new external industrial networks and advance their technologies closer to delivering societal and economic impact."
Jul 21 LSHTM press release


Canadian One Health report tackles antimicrobial resistance

Originally published by CIDRAP News Jul 21

The Canadian Veterinary Medical Association (CVMA) and the country's Antimicrobial Resistance (AMR) Network have published a new One Health–focused report that proposes improvements to a pan-Canadian AMR governance structure and optimal models for responding to AMR.

The report, "Strengthening Governance of the Antimicrobial Resistance Response Across One Health in Canada," proposed two approaches, or models, to address the AMR crisis. It says any approach must create connections and foster knowledge-sharing across One Health and across Canada, and it must increase capacity to accelerate action and deliver meaningful solutions.

The first model, called the AMR Network, "appeals to those who view the AMR ecosystem in Canada as complex, both in terms of the diversity of stakeholders involved and the range of actions that are required to address the issue at hand," according to the report. It gives One Health experts control of priorities.

The second model, dubbed the AMR Center, adopts a classic top-down approach and "enables a comprehensive approach to selecting its priorities, choosing to make meaningful impact in a select number of priority areas."

In a statement yesterday by the Public Health Agency of Canada (PHAC), Canadian Health Minister Patty Hajdu, MPA, said, "This report will help all parties move toward a One Health approach to tackle this universal issue. It will also serve as an important tool for discussions alongside the work the federal government is undertaking with provincial and territorial partners and with stakeholders to mitigate the potential impact of AMR and protect the health of Canadians."

PHAC funded the AMR Network to explore governance models that unite diverse stakeholders.
Jul 19 CVMA report
Jul 20 PHAC statement


Study ties superbug prevalence in the ED to ambulance rides

Originally published by CIDRAP News Jul 21

A study by Duke University scientists today reveals that patients arriving at their emergency department (ED) via ambulance were almost four times more likely to have methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection than those who didn't arrive by ambulance, though numbers of both were small.

The single-center retrospective cohort study, published in Infection Control & Hospital Epidemiology, involved 11,324 patients from 2016 to 2019. About one third (3,903) were in the ambulance group, with the remainder in the unexposed group.

Among them, 9 patients (0.08%) tested positive for MRSA and 3 (0.03%) for VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively. Patients who arrived at the ED via ambulance were almost four times more likely to have MRSA or VRE within 30 days of their encounter (relative risk, 3.72; 95% confidence interval, 1.09 to 12.71; P = .04).

The authors say a strength of their study is its stringent inclusion criteria to assess multidrug-resistant organism (MDRO) prevalence, but they also note that the study design did not account for all confounders. They write, "To our knowledge, our study represents the first controlled and matched analysis to evaluate the impact of ambulance exposure on the development of MDROs."
Jul 21 Infect Control Hosp Epidemiol study


ECDC notes alarming healthcare rise of OXA-244–producing E coli

Originally published by CIDRAP News Jul 20

In an update on a healthcare-related outbreak of OXA-244–producing Escherichia coli in Norway, the European Centre for Disease Prevention and Control (ECDC) said today that cases have doubled in the main cluster, and three new countries have reported cases.

Following its original risk assessment on Feb 18 after Norway reported 12 cases, health officials asked countries to submit samples for sequencing. Of 458 E coli ST38 isolates, 370 carried the blaOXA-244 gene encoding for the OXA-244 carbapenemase, which has the potential to confer resistance to the class of antibiotics known as carbapenems.

The isolates included several clusters, including a large one with 225 closely related isolates. Of those, 210 were from 11 countries in Europe and the United Kingdom. Fifteen were from other countries. People in the large cluster have a median age of 51, with a high proportion from women and samples frequently isolated from urine.

The ECDC said so far the source is unclear, and community transmission seems to be the main route of spread. Travel data are sparse but hint at North Africa or the Middle East as possible sources, consistent with the regions with previous links to OXA-48–like carbapenemases. It added that travel alone can't explain the rapid spread to 13 different European countries. A common animal or food source is also a possibility that requires further investigation, the agency said.

Little is known about the clinical consequences of carbapenems for OXA-244 E coli infections, but ECDC said the situation is concerning, given that OXA-48 like carbapenemases have been linked to treatment failures.
Jul 20 ECDC update

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