COVID-19 Scan for Jan 04, 2021

News brief

7-day quarantine may work for some COVID household contacts

Interim study results published late last week in Morbidity and Mortality Weekly Report (MMWR) found that only 19% of people exposed to a COVID-19 patient in their home who had no symptoms nor a positive test result in the first 7 days of the patient's illness later tested positive—lending support for recently changed Centers for Disease Control and Prevention (CDC) guidelines.

To shorten quarantine and improve compliance, a month ago the CDC revised its guidance and now recommends either 10 days of quarantine with no COVID-19 test or 7 days with a negative test result. But noting the risk of viral spread from people who develop symptoms or become infectious toward the end of the initially recommended 14-day quarantine, the researchers sought to quantify that risk.

In the ongoing CDC-supported study, 185 household members of 105 COVID-19 patients at Vanderbilt University Medical Center and Marshfield Clinic Research Institute completed a symptom diary and provided respiratory specimens for 14 days over April to September 2020.

Of 185 contacts, 109 (59%) tested positive during the study period, with 83 of the test results (76%) yielding positive results within 7 days, and 94 (86%) being positive within 10 days after the index patient became ill.

Contacts with negative COVID-19 test results and no symptoms in the first 7 days had an 81% chance of continuing to have no symptoms or test positive through day 14. Those odds increased to 93% for those without symptoms or positive test results in the first 10 days.

After excluding 22 households that may have had more than one index patient and 10 infected contacts who may have contracted the virus outside the home, the conditional probability that the contacts would remain uninfected in the first 14 days was 95% if they were asymptomatic and tested negative through day 10.

The researchers said that while a 14-day quarantine is the best strategy to reduce community coronavirus transmission, access to a sensitive COVID-19 test after a 7-day quarantine could identify infected household contacts and allow a shorter quarantine for those who remain asymptomatic and continue to test negative.

"A shorter quarantine after household exposure to COVID-19 might be easier to adhere to but poses some risk for onward transmission," the authors concluded. "Persons released from quarantine before 14 days should continue to avoid close contact and wear masks when around others until 14 days after their last exposure."
Jan 1 MMWR study
Dec 2, 2020, CIDRAP News story "CDC shortens COVID quarantine, adds holiday travel advice"


Study shows nations with women leaders not faring better in pandemic

Despite popular memes and media reports, countries with women leaders did not fare significantly better during the first several months of the COVID-19 pandemic than countries led by men, according to a study published late last week in PLOS One.

Though New Zealand, Taiwan, Iceland, Denmark, Finland, and Germany—among other countries—have been lauded for their response to the novel coronavirus, analysis of fatality data shows deaths are not significantly lower in these countries compared with those led by men.

The study authors looked at fatality data from 175 countries, 16 of which have female leaders, and ranked the pandemic through a system that looked at the day of the first reported case, the day of the first reported death, and the first day that the number of deaths was greater than 1 per million to compute deaths per capita 30, 60, 90, and 120 days after the start of the pandemic in each country.

There were no significant differences in fatality data between the two types of nations, and the authors instead said the perception that women were better leaders during the pandemic reflected a political double bind of female leaders needing to be both stereotypically masculine and feminine. Moreover, nations that elect female leaders may do so because the population has increased trust in government, which could ultimately lead to more effective pandemic response.

"The perspective that women have been better leaders during the pandemic is rooted in selection bias, based on the selective reporting of cases where women-led countries have succeeded in pandemic management," the study authors said. "These reports fail to acknowledge men-led countries that have done similarly well, while instead emphasizing carefully selected cases where men have not performed well."
Dec 31 PLOS One study


Allergists offer guidance on COVID-19 vaccines for those with allergies

A review published last week in the Journal of Allergy and Clinical Immunology: In Practice provides an outline of what is known about immediate allergic reactions associated with mRNA-based COVID-19 vaccines and offers guidelines on how patients with potential reactions should be managed.

The review, written by a team of US allergists, notes that despite some early reports of severe allergic reactions to the Pfizer-BioNTech vaccine, safety data from the phase 3 trials of both the Pfizer-BioNTech and Moderna vaccines are strong, and to date there have only been 12 reported allergic reactions to the vaccines across more than 2 million administered doses. But they recommend that those with a history of anaphylaxis to an injectable drug or vaccine containing polyethylene glycol or polysorbate speak with their allergists before being vaccinated.

To ensure that the vaccines are administered as quickly as possible and that patients with a prior allergy history receive the vaccines safely, the authors recommend a risk-stratification protocol that allows for the rapid assessment of patients with concerning anaphylaxis histories. They also recommend that vaccination clinic staff have education around anaphylaxis treatment guidelines, that allergists provide support to vaccination programs to ensure appropriate treatment and follow-up for patients who have reactions after their first shot, and that patients with a possible allergic reaction after the first shot be prioritized for further testing and support before their second shot.

"As allergists, we want to encourage vaccination by reassuring the public that both FDA-approved COVID-19 vaccines are safe," lead author Aleena Banerji, MD, of Massachusetts General Hospital (MGH) said in a hospital press release. "Our guidelines are built upon the recommendations of U.S. regulatory agencies and provide clear steps to the medical community on how to safely administer both doses of the vaccine in individuals with allergic histories."

Following reports that two UK recipients of the Pfizer-BioNTech vaccine experienced severe allergic reactions within 48 hours of receiving their first shot, the Food and Drug Administration recommended that both the Moderna and Pfizer-BioNTech vaccines not be given to individuals with a known history of allergic reactions to any components of the vaccine. In addition, the CDC advised that all patients be observed for 15 minutes post-vaccination by staff who can identify and manage such reactions. 
Dec 31 J Allergy Clin Immunol Pract abstract
Dec 31 MGH news release

News Scan for Jan 04, 2021

News brief

CDC study finds sharp drop in outpatient antibiotics in first half of 2020

A new study by researchers from the Centers for Disease Control and Prevention (CDC) shows a substantial decrease in the number of outpatients who received antibiotic prescriptions during the first 5 months of 2020 compared with previous years.

In the study, published last week in Clinical Infectious Diseases, CDC researchers looked at data from the IQVIA Total Patient Tracker to estimate the monthly number of patients dispensed prescriptions for commonly used antibiotics from retail pharmacies from January 2017 through May 2020. They averaged estimates from 2017 through 2019 to create a baseline, and defined the percent change from January through May in each year as the seasonally expected change. They then calculated the percent change in January through May 2020 and compared it to the previous years.

The results of the analysis showed that from January through May 2020, the number of outpatients dispensed antibiotic prescriptions fell from 20.3 million to 9.9 million, exceeding seasonally expected decreases by 6.6 million patients and 33 percentage points. The largest differences were observed in April and May, when the number of patients receiving outpatient prescriptions was 39% and 42% lower, respectively, than the 2017-2019 averages for those months.

The largest beyond-expected decreases were observed in prescriptions for penicillins (2.3 million fewer patients), macrolides (1.5 million fewer patients), and cephalosporins (1.1 million fewer patients). Trends in azithromycin prescribing varied slightly, with the number of patients receiving azithromycin climbing by 5% from January through March 2020 and then declining by 71% from March through May. Beyond-expected decreases in dispensed antibiotics were observed across age groups, with the greatest decline occurring in children 4 and under and adults 65 and over.

The authors of the study say it's unclear at this point whether the decreases were driven by declines in non-COVID-19 disease transmission or changes in care-seeking related to the COVID-19 pandemic.

"Ongoing surveillance of antibiotic prescribing, antibiotic-associated adverse events, antibiotic-resistant infections, and complications of common infections is needed to evaluate the longterm impacts of these changes in outpatient antibiotic trends," they wrote. "Shifts in healthcare delivery, particularly the use of telehealth, are likely to be sustained, and should prompt assessment of effective antibiotic stewardship interventions to optimize antibiotic prescribing practices and ensure patient safety."
Dec 28 Clin Infect Dis abstract


More vaccine-derived polio cases, including first in Sierra Leone

Four countries reported new polio cases last week, all involving circulating vaccine-derived poliovirus type 2 (cVDPV2), including the first in Sierra Leone, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

In the Middle East, Afghanistan reported 26 more cVDPV2 cases in 10 provinces, with 9 reported in Kandahar. The country has now recorded 240 such cases for 2020.

Three African countries also added to their cVDPV2 totals for the year. Sierra Leone reported its first three cases, one each in Western Area, Northern, and North Western provinces. Neighboring Guinea reported 7 more cases in five different provinces, raising its 2020 total to 36. And Nigeria reported a case in Sokoto state, putting its total at seven.
Dec 31 GPEI update


High-path avian flu strikes more poultry and wild birds in Asia, Europe

In the latest highly pathogenic avian flu outbreaks, South Korea and France reported more H5N8 outbreaks in poultry and several countries reported more detections in wild birds, according to the latest notifications from the World Organization for Animal Health (OIE).

South Korea reported 15 more outbreaks in poultry from six different provinces: Gyeonggi, North Chungcheong, North Jeolla, South Jeolla, South Chungcheong, and North Gyeongsang. The events began from Dec 20 to Dec 28 affecting commercial farms, mainly those housing ducks. Taken together, the virus killed 1,314 of 867,931 birds. South Korea also reported 15 more H5N8 detections in waterfowl in different parts of the country.

Taiwan reported two more outbreaks involving highly pathogenic H5N5, one at a layer farm in Changhua County and one at a goose farm in Yunlin County. Between the two outbreaks, the virus killed 5,200 of 35,384 birds. Taiwan has been battling H5N5 outbreaks in poultry since September 2019.

In France, agriculture officials reported 16 more poultry outbreaks involving H5N8, all of them on duck farms in Landes department in the southwest. The outbreaks began from Dec 22 to Dec 28, killing 26 of 59,625 birds. A handful of European countries also reported more detections involving wild birds, mostly H5N8 but also the European strain of H5N1 in the United Kingdom and H5N5 in Slovenia.
Dec 30 OIE report on H5N8 in South Korean poultry
Jan 3 OIE report on H5N8 in South Korean wild birds
Jan 4 OIE report on H5N5 in Taiwan
Dec 31 OIE report on H5N8 in France
Dec 31 OIE report on H5N1 in UK wild birds
Dec 31 OIE report on H5N8 in UK wild birds
Jan 4 OIE report on H5N5 in Slovenia

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