COVID-19 Scan for Sep 01, 2021

News brief

Pre-hospital antiplatelet therapy linked to lower COVID-19 death rates

Pre-hospital antiplatelet therapy, most commonly aspirin, was associated with significantly lower in-hospital mortality rates for COVID-19 patients, according to a study this week in the Journal of Thrombosis and Haemostasis.

The researchers matched 6,781 COVID-19 US patients who received antiplatelet therapy before hospital admission with 10,566 who did not receive antiplatelet therapy from February to September 2020. In this 1:1.6 ratio, data showed that those who received antiplatelet therapy had an in-hospital mortality rate of 18.9%, whereas those in the control group had a 21.5% in-hospital mortality rate (hazard ratio, 0.81; 95% confidence interval, 0.76 to 0.87). The antiplatelet therapy group also showed a lower rate of pulmonary embolism (2.2% vs 3.0%) but a higher rate of nosebleeds (0.9% vs 0.4%). No other clotting complications occurred.

Pre-matching, the total pool of patients was 34,675 people 50 or older across 90 US health systems (median age, 69 years). Almost 20% (6,781) had received pre-hospital antiplatelet therapy, with aspirin being the most common (83.9%), followed by clopidogrel (8.2%), and dual antiplatelet therapy occurred in 7.4%. About 30% of patients who didn't receive pre-hospital antiplatelet therapy later received it during their hospitalization.

"Importantly, most patients in the antiplatelet therapy arm received aspirin, which is a widely available medication that is inexpensive and has a well described risk profile," the researchers write. "Future studies are necessary to determine if mortality outcomes are different for P2Y12 antagonists, COX-1 inhibitors, or phosphodiesterase inhibitors."
Aug 29 J Thromb Haemos


Study: High-risk allergy patients have low reaction rates to Pfizer vaccine

Of 429 patients considered to be high-risk for allergic reactions against the Pfizer/BioNTech COVID-19 vaccine, 98% had no allergic reaction, according to a JAMA Network Open study yesterday.

From Dec 27, 2020, to Feb 22, 2021, 8,102 Israeli patients with allergies applied to the COVID-19 vaccine referral center at the Sheba Medical Center near Tel Aviv. Overall, 85.0% were referred to receiving vaccination in regular settings, 1,219 received further assessment, and 429 (5.3%) were considered high-risk and received the Pfizer vaccine under medical supervision.

After the first dose, 97.9% of the high-risk group had no allergic reactions. Of the 218 who received their second dose during the study period, 98.2% had no allergic reactions.

Nine patients experienced allergic reactions after the first dose. Six had mild reactions that resolved with antihistamines during the observation period, and three had anaphylaxis within 10 to 20 minutes post-vaccination. The anaphylaxis resolved within 2 to 6 hours after adrenaline, antihistamines, an inhaled bronchodilator, and—for one patient—systemic glucocorticoids. None required hospitalization.

After the second dose, four patients had minor allergic reactions, which were treated with antihistamines and bronchodilators. Three of the four had experienced mild reactions after the first dose and had received premedication prior to the second.

"We enabled immunization of most patients with allergies by using a simple algorithm that included a referral center, a risk assessment questionnaire, and a safe environment for immunization of highly allergic patients with observation after immunization," write the researchers.

The high-risk group was 70.9% women, and the mean age was 52 years. Most had a history of anaphylaxis (63.2%), and many had multiple allergies (30.3%), had multiple drug allergies (32.9%), and carried an adrenaline syringe (22.1%).

"Interestingly, the low-risk allergy groups included many of those overrepresented in anaphylaxis reports in the Centers for Disease Control and Prevention's Vaccine Adverse Event Reporting System (VAERS): those who had chronic urticaria; sensitivity to foods, venoms, or aeroallergens; or nonanaphylactic reactions to drugs or contrast media," notes Elizabeth J. Phillips, MD, of Vanderbilt University, in a related commentary.
Aug 31 JAMA Netw Open study and commentary

News Scan for Sep 01, 2021

News brief

Vietnamese study finds benefits from CRE screening in newborns

Admission screening for carbapenem-resistant Enterobacterales (CRE) at a Vietnamese children's hospital was associated with reduced CRE acquisition, hospital-acquired infections (HAIs), duration of hospital stay, and costs, according to a study published this week in Antimicrobial Resistance and Infection Control.

In the prospective intervention cohort study, a team of Swedish and Vietnamese researchers assessed the effectiveness of CRE admission screening and cohort care in three intensive care units (ICUs) at Vietnamese National Children's Hospital. During the intervention, all newborns admitted to the ICU were screened upon admission, then treated in cohorts base on CRE colonization status. Newborns who initially tested negative were screened once a week. The primary outcomes were CRE acquisition and colonization, HAI rate, and treatment outcome and costs.

Of 941 newborns screened at admission, 337 (35.8%) were CRE-positive. Of the 694 patients that met inclusion criteria, 244 who were CRE-negative at admission and screened more than two times were stratified in eight similarly sized groups (periods), based on time of admission. In the three ICUs combined, CRE acquisition decreased significantly (odds ratio, [OR], − 3.2) over the eight periods, from 90% in period 2 to 48% in period 8.

CRE acquisition was significantly correlated with culture-confirmed HAI, weeks of hospital stay, and total treatment cost. Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI (14% vs 2%), longer hospital stays (3.26 vs. 2.37 weeks), and higher total treatment costs ($2,852 vs. $2,295 USD).

"The admission CRE screening and cohort care intervention showed that CRE acquisition can be reduced with limited resources and be cost-effective by reducing CRE colonization, HAI, and duration of hospital stay," the study authors wrote. "As large proportions of patients were CRE colonized at admission, indicating a significant CRE spread in non-tertiary level hospitals, CRE screening should be implemented in all healthcare levels in the endemic Vietnamese system."

The authors add that, since their study contained no control group, a randomized controlled trial is needed to better assess the impact of CRE screening and cohort care.
Aug 30 Antimicrob Resist Infect Control study


Confirmation tests rule out Ebola in recent Ivory Coast case

Follow-up tests on Ivory Coast's recent Ebola case, involving a woman who had traveled from Guinea, were negative, the World Health Organization (WHO) African regional office said yesterday.

The negative findings were found after a second round of tests at the Pasteur Institute in France. Initially, tests at the Pasteur Institute lab in Ivory Coast had confirmed Ebola in the 18-year-old woman's samples on Aug 14.

Further analysis of the cause of the woman's infection is under way. Of the 140 contacts identified, no other illnesses or positive Ebola findings were noted. The woman was hospitalized and has recovered, according to media reports.

The initial positive test findings triggered a responses in Ivory Coast and Guinea, including the deployment of vaccine for frontline health workers and people identified for ring immunization.

The WHO said it has downgraded its actions in Ivory Coast from response to readiness mode. The Ivory Coast reported its last Ebola case in 1994, which involved a scientist who contracted the virus from an infected chimpanzee.
Aug 31 WHO African regional office statement


Global flu stays low, tilts toward influenza A

In a global flu update that covers the first half of August, flu levels remained very low in both hemispheres, detections continue to increase in Southern Asia countries India and Nepal, with sporadic detections elsewhere, including in the Americas region, the WHO said in its latest global flu update.

Most of the activity in India and Nepal is due to H3N2. In the Americas, sporadic detections of both influenza A and B were reported in the Caribbean, Central America, and Mexico. Elsewhere, some countries in East and West Africa continue to report flu cases.

Of the few respiratory samples that tested positive for flu from Aug 2 though Aug 15, 65.1% were influenza A and 34.9% were influenza B. Of the subtyped influenza A samples, 93.8% were H3N2. All of the characterized influenza B samples were the Victoria lineage.

The WHO included its usual caveat that the global flu patterns should be interpreted with caution, given potential impacts from COVID-19 surveillance and response measures.
Aug 30 WHO global flu update

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