COVID-19 Scan for Nov 01, 2022

News brief

State Republican majority tied to higher COVID death rates after vaccine rollout

After the COVID-19 vaccine rollout to adults, Americans living in states with Republican-controlled governments were at an 11% higher risk of COVID-19 death than those in Democrat-led states, and residents of right-leaning states had a 26% higher death rate than those in states with a left-leaning voter majority.

The observational findings were published yesterday in The Lancet Regional Health.

Harvard investigators analyzed age-standardized COVID-19 death rates and local intensive care unit (ICU) patient loads for all 435 US Congressional districts after the vaccine rollout from April 2021 to March 2022, while controlling for sociodemographic factors, population density, COVID-19 vaccination rates, rates of diabetes and obesity, and voter political lean.

The team determined political majorities by evaluating each elected representative and senator's overall and COVID-19 voting records, state trifecta status (governor, state House of Representatives, and state Senate all under the control of one political party), and voter political leaning using records from the 2016 and 2020 presidential elections.

Most (75%) state representatives voted in favor of all four COVID-19 relief bills. Forty-one percent of representatives were in states with Republican trifectas, while 35% had Democratic trifectas, and 25% had divided governments.

Republican trifecta and right voter lean were independently tied to respective 11% and 26% higher COVID-19 death rates, and US senator voting records were significantly and independently linked to an increase of 3.5 percentage points in ICU occupancy. Low COVID-19 relief bill support was also associated with higher death rates. The patterns remained throughout the study period, which included the Delta and Omicron variant waves.

The authors noted that federal and state officials play key roles in obtaining and allocating COVID-19 resources and in setting norms of institutional and social behavior via their actions, campaign messages, and constituent messages.

"Especially in a time of increasingly polarized politics, it is critically important to monitor and analyze population health data mapped onto meaningful units of political geography in conjunction with informative political variables that can aid ascertainment of political accountability and democratic governance," they wrote.
Oct 31 Lancet Public Health study

Study suggests good outcomes in 6 months after prenatal COVID infection

A new study in Pediatrics shows generally good outcomes during the first 6 months of life among infants born to women who had a COVID-19 infection during pregnancy.

This reassuring finding suggests maternal-to-newborn infections are rare when maternal infections occur in the 14 or fewer days before birth. Previous studies have shown that maternal COVID-19 infections are associated with increased preterm birth and stillbirth risk and may be associated with preeclampsia, or potentially dangerous high blood pressure during pregnancy.

The study was conducted on maternal-infant pairs who followed for 6 months before Mar 1, 2022, in 10 jurisdictions, including the city of Houston (Texas), the territory of Puerto Rico, and the states of Kansas, Minnesota, Nebraska, New Jersey, New York (excluding New York City), South Carolina, Tennessee, and Washington.

Most reported maternal infections occurred at 20 weeks gestation or later (73.3% [95% confidence interval [CI], 69.6 to 76.9]). Nearly one-half of maternal records (43.3% [95% CI, 39.7 to 46.8]) had insufficient information to define COVID-19 illness severity, 16.8% (95% CI, 13.7 to 19.9) had an asymptomatic infection, and illness was mild in 29.7% (95% CI, 26.2 to 33.3), moderate to severe in 8.6% (95% CI, 7.2 to 10.1), and critical in 1.6% (95% CI, 1.1 to 2.0).

More than 85.6% of infants who experienced maternal prenatal infection were born at term (37 or more weeks), and (96.7% [95% CI, 95.8 to 97.7]) had no birth defect diagnosis through 6 months of age

"Only 0.6% (0.5–0.7) of infants included in the study tested positive, 10.2% (9.2–11.3) tested negative, and 89.1% (88.0–90.3) were not known to be tested for COVID-19 in the late postnatal period (15 days to 6 months of age)," the authors wrote.

"The incidence of SARS-CoV-2 infections in the early postnatal period was higher when maternal infection occurred in the 14 days preceding delivery, and most infant infections occurred between 15 days and 6 months of age. Breastmilk feeding initiation was lower when maternal infection occurred in the 14 days preceding delivery and all-cause mortality was higher," the authors concluded.
Nov 1 Pediatrics study

News Scan for Nov 01, 2022

News brief

WHO keeps monkeypox public health emergency in place

The World Health Organization (WHO) monkeypox emergency committee met for the third time on Oct 20 to discuss the latest developments, concluding that the situation still warrants a public health emergency of international concern (PHEIC).

In a statement today on their deliberations, the group said progress has been made, such as behavioral interventions and increasing vaccine uptake. However, they raised concerns about ongoing transmission in some regions, health inequities in a number of countries, and impacts on vulnerable populations, especially in those with HIV and in countries with weak health systems.

The group noted that since the public health emergency was declared on Jul 23, many countries responded to the outbreak, which led to interventions that have driven down cases as the global level. However, officials said the progress reflects a mixed picture. The global risk is currently moderate, but is high in the Americas. The risk declined from high to moderate in the European region, remained at moderate in the African, Eastern Mediterranean, and South-East Asia regions, and remained low in the Western Pacific region.

WHO emergency committees typically meet every 3 months or more often as needed.

In US developments, the Centers for Disease Control and Prevention (CDC) yesterday reported 75 more monkeypox infections, raising the national total to 28,377. The global total is currently 77,092 cases from 109 countries, including 7 with historical cases.
Nov 1 WHO statement
CDC monkeypox updates
CDC global monkeypox map

Study finds suboptimal adherence to short-term antibiotics

A study of Israeli children with acute bacterial infections found that fewer than two-thirds adhered to antibiotic treatment, researchers reported today in Pediatrics.

In the prospective, blinded, observational study, researchers at a tertiary medical center in Israel electronically monitored patients ages 2 months to 5 years who had been discharged with short-term oral antibiotics (5 to 10 days) after being diagnosed with an acute bacterial infection from January 2018 through December 2021. Diagnoses included acute otitis media (AOM, or ear infection), pneumonia, cellulitis, pharyngitis, urinary tract infection, and bacteremia.

The primary outcomes were overall treatment adherence (defined as administration of more than 75% of doses relative to the number of doses prescribed) and timing adherence (administration of more than 75% of doses at the recommended time interval). Monitoring was conducted via medication bottles that recorded time and date every time they were opened.

Among the 100 infants included in the final analysis (49 boys; mean age, 1.87 years), AOM was the most common diagnosis (18 children), followed by cellulitis and UTI (16 and 14 children, respectively). Overall treatment adherence was 62%, while timing adherence was 21%. Logistic regression analysis found that the only factor associated with nonadherence was parental status, with single parents having a five-fold increase in odds for nonadherence (odds ratio, 5.7; 95% confidence interval [CI], 1.07 to 30.3).

The study also found that prescribers overestimated adherence to treatment, defining 49 of 62 participants (77.7%) as likely adherent, and were unable to differentiate between adherers and nonadherers.

The study authors say that while treatment adherence studies have largely focused on chronic conditions that require prolonged adherence to medication, it's become increasingly recognized that nonadherence to short-term interventions can result in serious consequences. With antibiotics, it can also potentially increase the development of drug-resistant microorganisms.

"These data are important when considering recommended treatment durations and developing interventional programs to increase adherence," they wrote.
Nov 1 Pediatrics study

Pfizer details promising RSV vaccine findings in newborns

Pfizer today announced promising findings suggesting that an investigational respiratory syncytial virus (RSV) vaccine in pregnant women can substantially cut severe RSV illness in their newborns.

As a result, the company said in a press release that it will file for regulatory approval with the US Food and Drug Administration (FDA) by the end of 2022.

The ongoing global phase 3 trial evaluated medically-attended lower respiratory tract infections — as well as severe illnesses — in babies born to pregnant women who were vaccinated during pregnancy. Researchers enrolled nearly 7,400 pregnant women, half of whom were randomized to receive a single dose of Pfizer's RSV vaccine during the second or third trimester. The study was also designed to assess safety in pregnant women, who were followed for 6 months after delivery. The babies were followed for at least one year to gauge safety and efficacy, with more than half followed for 2 years. The study began in June 2020, spanning multiple RSV seasons.

Vaccine efficacy against severe disease during the first 90 days of life was high at 81% (confidence interval [CI] 40.6% to 96.3%. And when extended over 6 months, vaccine efficacy against severe disease was 69.4% (CI 44.3% to 84.1%).

Against less severe but still medically attended infections in babies, the secondary endpoint was not met, but was still clinically meaningful with an efficacy of 57.1% (CI 29.4% to 66.8%) over the 6-month follow-up period.

Researchers found no safety concerns in their monitoring of mothers and babies.

Annaliesa Anderson, PhD, senior vice president and chief scientific officer of vaccine research and development at Pfizer, said the company is thrilled by the data.

"We look forward to working with the FDA and other regulatory agencies to bring this vaccine candidate to expectant mothers to help protect their infants against severe RSV during their most vulnerable first six months of life, which has the highest burden of RSV illness in infants," she said.

The development comes at a time when RSV cases are unseasonably high in the United States, which has put pressure on pediatric hospital wards in several states. Researchers have also said an RSV in infants has the potential to reduce antimicrobial prescribing in infants, making the vaccines a possible antimicrobial stewardship tool.
Nov 1 Pfizer press release

WHO warns of worsening cholera spread in Lebanon

A cholera outbreak in Lebanon—its first in three decades—is worsening and has now rapidly spread from the north to all of the country's governorates, the World Health Organization (WHO) warned yesterday.

The first case was reported on Oct 5, and since then, more than 1,400 suspected cases have been reported, 381 of them lab confirmed. So far, 17 people have died from their infections. The WHO said the Vibrio cholerae O1 El-Tor Ogawa serotype is similar to the once circulating in bordering Syria.

In a statement, Abdinasir Abubakar, MD, MPH, the WHO's representative in Lebanon, said the country's situation is fragile due to prolonged political and economic problems. The WHO has deployed supplies and staff to the hardest hit areas and is sending more cholera supplies.

Despite a global shortage of vaccines, the WHO is helping Lebanon's health ministry obtain 600,000 doses for the most vulnerable groups, including frontline workers, prisoners, as well as refugees and their host communities.

Since January, 29 countries have reported outbreaks, which the WHO said are becoming more numerous due to floods, droughts, population movement, and other factors that limit access to clean water. Due to the unprecedented rise in global cholera activity, the group that coordinates cholera vaccine distribution recently suspended the two-dose regimen in favor of one dose to help stretch vaccine supplies.
Oct 31 WHO Eastern Mediterranean regional office statement