COVID-19 Scan for Dec 02, 2020

News brief

Cancer patients may shed viable COVID-19 virus for 2 months

A New England Journal of Medicine study yesterday of cancer patients with COVID-19 demonstrated viral RNA shedding for up to 78 days and live virus for up to 61 days, suggesting extended infectiousness in patients whose immune system is suppressed.

Live-virus shedding in patients who are not immunocompromised is well-documented, but little is known about how long immunocompromised patients—including those receiving cancer treatments—are contagious. The presence of viral RNA does not always correlate with transmissibility, and previous studies have demonstrated lengthy periods of viral RNA shedding after patients are no longer infectious.

Scientists at Memorial Sloan Kettering Cancer Center collected respiratory samples from 20 cancer patients receiving immune-suppressing therapy from Mar 10 to Apr 20. Nasopharyngeal samples were tested for SARS-CoV-2, the virus that causes COVID-19, using reverse-transcription polymerase chain reaction (RT-PCR). Viral culture of positive swabs was used to assess the presence of infective particles and whole-genome sequencing was conducted for viral samples.

Of the 20 patients, 15 were receiving active treatment or chemotherapy and 11 had severe COVID-19. Viral RNA was detected in the cancer patients up to 78 days after the onset of symptoms (interquartile range [IQR], 24 to 64 days). Viable virus was detected in 71% of initial nasopharyngeal samples and grew in cultures from five patients up to 61 days after symptom onset.

Whole-genome sequencing of viral samples suggested persistent infection with a single viral strain.

"Patients with profound immunosuppression after undergoing hematopoietic stem-cell transplantation or receiving cellular therapies may shed viable SARS-CoV-2 for at least 2 months. The current guidelines for COVID-19 isolation precautions may need to be revised for immunocompromised patients," the study authors wrote.
Dec 1 N Engl J Med study

Outsize COVID-19 burden noted in Hawaii's Pacific Islanders

A report in the International Journal of Infectious Diseases yesterday highlights the disproportionate burden of COVID-19 among Pacific Islanders in Hawaii: They represent 4% of the state population but make up 31% of COVID-19 cases.

Hawaii reported its first confirmed case of COVID-19 on the main island of Oahu on Mar 6. Sharp peaks in cases occurred in March and April, attributed mostly to returning residents and visiting tourists. A mandatory 14-day isolation of all incoming visitors and returning residents on Mar 23 led to a decrease in cases, but transmission rebounded in late July and peaked at the end of August after a stay-at-home order lifted and many non-essential businesses reopened.

As of Oct 30, a total of 15,003 COVID-19 cases have been reported in the state.

Hawaii's multi-ethnic population includes large subpopulations descended from Asians, native Hawaiians, other Pacific Islanders and Europeans, as well as many recent immigrants. Pacific Islanders—80% of whom reside in Honolulu—come primarily from American Samoa, Micronesia, the Marshall Islands, and Palau.

Pacific Islanders had a COVID-19 case rate of 448 per 100,000 people on Jul 17, 7.5 times higher than the combined rate for all other non–Pacific Islanders (59.7 per 100,000). The Pacific Islander case rate increased during every 7-day interval after Jul 17, reaching 31% of the total reported COVID-19 cases as of Oct 30.

Hawaiian Pacific Islanders are younger (median age between 18.5 and 23.7 years), less educated, and have lower per capita incomes than the overall Hawaiian population. They are also more likely to work in frontline service jobs, particularly in the tourist sector.

"Local explanations for the high COVID-19 rates in Pacific Islanders have been inferred from observations that Pacific Islander households in Hawai'i tend to be multi-generational, leading to crowded living quarters," the authors noted. "This makes physical distancing difficult."
Dec 1 Int J Infect Dis study

News Scan for Dec 02, 2020

News brief

Higher-than-expected antibiotic prescribing during UK COVID lockdown

Telephone consultations could be the reason why antibiotic prescribing at general practices in the United Kingdom was higher than expected during the first COVID-19 lockdown, researchers with the University of Nottingham reported yesterday in the Lancet Infectious Diseases.

Examination of National Health Service data from Apr 1 to Aug 31 showed that while the number of face-to-face appointments fell by 51.5% compared with the corresponding period in 2019, telephone consultations increased by 270.5%. The absolute number of appointments was 20.8% lower than in the corresponding period in 2019.

Based on the reduction in the absolute number of appointments, the researchers determined that the 15.5% decrease in antibiotic prescribing in 2020 was still 6.7% higher than expected. They suggest this finding indicates antibiotic prescribing rates are higher in remote consultations than during in-person consultations.

"This increase could reflect the greater diagnostic uncertainty that results from an inability to examine patients and perform investigations during telephone appointments, which might lead clinicians to take greater precautions in cases of possible infection," the authors wrote.

The authors also said that with telephone consultation volumes remaining high during the pandemic, clinicians need support to use antibiotics appropriately.
Dec 1 Lancet Infect Dis correspondence

Meningococcus vaccine Bexsero found 79% effective in youth

The 4CMenB vaccine, or Bexsero, is 79% effective in children, according to a study published yesterday in JAMA. In a matched case-control study, researchers looked at the health records of 98 youth who had lab-confirmed meningococcus—82 of whom had group B meningococcal disease—and 201 controls who did not have meningococcal disease.

While 70.4% of the children with group B meningococcus were old enough to have been fully immunized, only 7% had received the correct amount of vaccine dosages, compared with 23% of the control patients. No related disabilities occurred in ill children who received at least one vaccine dosage (11.2% of the 98 patients), but of those who did not receive vaccinations, 7 died and 16 suffered long-term injuries.

Cases were identified from October 2014 to March 2019 across 31 pediatric hospitals in Portugal, and each was matched with up to three control cases similar in demographics. The researchers noted they found similar vaccine efficacy results when looking at non-group B meningococcal strains.

"Although rare, meningococcus group B infection can become life-threatening within hours and can cause long-term disabilities," said senior author Adam Finn, PhD, in a University of Bristol news release. "Young children in particular are more at risk and may die or be seriously harmed even with top quality hospital treatment."

Bexsero, which is manufactured by Novartis, has been approved for use in Europe since 2013 and in the United States since 2015.
Dec 1 JAMA study
Dec 1 University of Bristol press release