COVID-19 Scan for Jan 14, 2021

News brief

Phase 1 and 2 trials show J&J COVID vaccine safe, immune-producing

Interim phase 1-2a results from Johnson & Johnson's COVID-19 vaccine trials show that its vaccine, Ad26.COV2.S, produces a good immune response and safety profile, according to a New England Journal of Medicine study yesterday.

Unlike the two messenger-RNA vaccines currently in use in the United States, the Johnson & Johnson vaccine uses a recombinant, non-replicating adenovirus 26 (Ad26) with a complete and stabilized spike protein.

"A single dose of Ad26.COV2.S elicited a strong humoral response in a majority of vaccine recipients, with the presence of S-binding and neutralizing antibodies in more than 90% of participants, regardless of either age group or vaccine dose," write the researchers.

The researchers gave one or two doses of a low- or high-dose vaccine or placebos to 402 people aged 18 to 55 and 403 people 65 and older. Almost 95% of the US and Belgian participants were white.

Mild to moderate adverse events included fever, fatigue, headache, myalgia, and injection-site pain. In the younger group, 15 (9.3%) low-dose recipients and 32 (20.3%) high-dose recipients reported severe systemic events, compared with 1 (0.6%) and 4 (0.2%) in the older group. One participant (0.1%) had a vaccine-related fever that required hospitalization, but it resolved within 12 hours.

The researchers found that, 29 days after vaccination, the neutralizing-antibody geometric mean titer (GMT) level in younger people was 224 (after one low dose) to 354 (after two high doses), with at least 99% seroconversion. In older recipients, day 29 results ranged from 277 (one low dose) to 212 (one high dose) GMT, with at least 96% seroconversion. Titers increased and remained stable through day 71 in the younger cohort, ending between 321 (one low dose) and 1,266 (two high doses). They were not measured beyond day 29 in the older cohort.

As studies continue, the researchers will assess the benefit of a second vaccine dose for the elderly. If the vaccine receives an emergency-use authorization from the Food and Drug Administration, Johnson & Johnson has a deal with the US Department of Health and Human Services for 100 million doses, although The New York Times reports that manufacturing is behind schedule.
Jan 13 N Engl J Med study


Men more vulnerable to COVID-19 complications, death, than women

Men are more likely to test positive for COVID-19, have complications, and die from their infections than females—regardless of age, according to a study published yesterday in PLOS One.

The study, led by researchers at Houston Methodist Research Institute in Texas, used electronic medical record data from a large healthcare provider to analyze the link between sex and COVID-19 in 14,992 adults from Mar 2 to Aug 22, 2020.

Among 96,473 adult patients tested for COVID-19, 14,992 (15.6%) had positive results; 4,785 (31.9%) of them were hospitalized, and 452 (9.5%) died. The positive testing rate was 15.5% among all patients and was higher in men than women (17.0% vs 14.6%; odds ratio [OR], 1.20). The sex difference was unchanged after adjustment for age, race, ethnicity, marital status, insurance type, median income, body mass index, smoking status, and 17 underlying illnesses included in the Charlson Comorbidity Index (adjusted OR, 1.39).

Men were also more likely than women to develop pulmonary complications such as acute respiratory distress syndrome and respiratory failure with low oxygen levels, and nonpulmonary complications such as acute kidney injury, during hospitalization. Women had lower rates of in-hospital death than men (8.3% vs 11.6%; OR, 1.44).

Men were significantly more likely to require intensive care than women (34.1% vs 27.6%; OR, 1.36). More men than women required mechanical ventilation (19.0% vs 14.7%; OR, 1.36). The men in the cohort were significantly older than the women (mean age, 53.3 vs 49.8 years) and predominantly white (66.7% vs 64.0%).

Underlying medical conditions such as high blood pressure, heart attack, congestive heart failure, peripheral vascular disease, cerebrovascular disease, diabetes, cancer, and HIV/AIDS were much more prevalent in men However, preexisting illnesses such as rheumatic disease, chronic pulmonary disease, mild cognitive impairment/dementia, and other neurological conditions, were more common in women.

"Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients," the authors wrote. 
Jan 13 PLOS One study


College students report high levels of COVID-19 pandemic distress

Another study published in PLOS One finds that upwards of half of all US university students have experienced high levels of distress early in the COVID-19 pandemic.

A team headed by Clemson University researchers analyzed data from online questionnaires collected from 2,534 students at seven large state universities from mid-March to early May, 2020, when most were under stay-at-home orders.

The researchers noted that college students are known to be especially vulnerable psychologically, experiencing more depression, anxiety, substance abuse, and eating disorders than the rest of the US population. They are also, the authors said, among the most strongly affected by the pandemic because of worries about academic success, future work possibilities, and social life.

All respondents indicated being affected negatively by the coronavirus pandemic in some way, with 59% reporting high levels of psychological distress. Factors associated with higher levels of psychological impact were female sex, non-Hispanic Asian race, fair or poor health, below-average family income, knowing someone infected with COVID-19, and having more than 8 hours of screen time daily.

Conversely, factors linked to a lesser psychological impact included white race, higher socioeconomic status, and spending 2 or more hours outside daily. Of all respondents, 61% were women, 79% were white, and 20% were graduate students.

The authors suggest that college administrators find ways to support students' mental health and academic success during the pandemic to avert long-term consequences. Such actions might include holding virtual group exercise and mindfulness sessions, exercise challenges, online social events, healthy mindset trainings, outreach to particularly at-risk groups, peer mentoring, remote office hours, and virtual counseling sessions and having "accountability buddies."

The researchers said that students must have their basic physiological, psychological, and safety needs met before they can excel in college. "We recommend that university administrators take aggressive, proactive steps to support the mental health and educational success of their students at all times, but particularly during times of uncertainty and crisis," they wrote.
Jan 7 PLOS One study

News Scan for Jan 14, 2021

News brief

Study finds high antibiotic use in Indian hospitals

A point-prevalence study conducted in five hospitals in India shows high use of antibiotics in admitted patients, with a considerable proportion coming from a category of broad-spectrum drugs with a higher potential for promoting antibiotic resistance, Indian researchers reported in the Journal of Antimicrobial Chemotherapy.

The survey, conducted over 2 weeks in May 2019 at five tertiary care centers in India, aimed to collect data on antibiotic prescribing patterns and practices in the country's hospitals, which are in the nascent stages of developing antimicrobial stewardship programs. The researchers collected data on all admitted patients in wards and intensive care units over the study period to determine indications for antibiotic use and the percentage of patients on antibiotics, receiving more than one antibiotic, and on antibiotics from the Watch and Reserve categories of the World Health Organization's Essential Medicines List.

A total of 3,473 patients were included in the study. Of these patients, 1,747 (50.3%) were on antibiotics, with 46.9% being treated with two or more antibiotics. The most common indications for antibiotic use were community-acquired infections (40.6%), surgical prophylaxis (32.6%), and hospital-acquired infections (13.5%).

Drugs from the Watch category accounted for 80.6% of prescriptions, with third-generation cephalosporins being the most widely used. Carbapenems, considered Reserve antibiotics, accounted for 11.3% of antibiotic use.

The WHO's Access, Watch, and Reserve antibiotic classification framework was introduced in 2017 to provide an indirect indication of the appropriateness of antibiotic use at national and global levels. Watch antibiotics are broader-spectrum drugs that are not recommended for routine use because of their higher potential for promoting resistance, while Reserve antibiotics are considered last-resort antibiotics that should be used only for multidrug-resistant infections. The authors of the study say it is difficult to know whether the use of these antibiotics was appropriate or not.

"The findings of the survey were helpful in generating baseline data for identifying strategies for interventions directed at reducing antimicrobial use and for evaluating the impact of future interventions," the authors of the study wrote.
Jan 11 J Antimicrob Chemother abstract


CDC: US sees nearly half a million Lyme disease cases annually

A Centers for Disease Control and Prevention (CDC) report yesterday based on insurance claims data in Emerging Infectious Diseases shows that Lyme disease was diagnosed in approximately 476,000 US patients annually from 2010 to 2018, an increase from the 329,000 annually diagnosed from 2005 to 2010.

The increase mirrors and confirms cases reported through surveillance, the authors said.

The study was based on commercial claims identified from the IBM Watson Health MarketScan Commercial Claims and Encounters Databases, which includes inpatient, outpatient, and prescription services for more than 25 million privately insured US residents under 65 years of age.

The researchers calculated that about 476,000 Lyme cases occurred each year from 2010 through 2018, with a range of 405,000 to 547,000. Though Lyme patients were identified across the United States, 81% of these diagnoses occurred among residents of 14 high-incidence states in the Northeast, mid-Atlantic, and upper Midwest, the CDC said.

"Our findings underscore the large clinical burden associated with Lyme disease diagnoses in the United States. Evolving electronic medical and laboratory systems should help fill demonstrable data gaps and enable more robust and reliable monitoring of changes in the magnitude and spread of the disease," the authors concluded.
Jan 13 Emerg Infect Dis


Avian flu strikes again in several country, including H5N1 in Cambodia

Several countries reported more highly pathogenic avian flu outbreaks in poultry, including the reappearance of H5N1 in Cambodia, more H5N6 events in Vietnam, and more H5N8 detections in Europe, according to the latest notifications from the World Organization for Animal Health (OIE).

Cambodia reported an H5N1 outbreak in village birds in Battambang province, its first involving the strain since 2019. The outbreak began on Jan 5 and killed 1,827 of 1,990 susceptible birds. So far, the source of the virus isn't known.

Vietnam reported five H5N6 outbreaks in village poultry in four provinces, including northern Bac Ninh, Ha Noi, and Quang Ninh in the north and Phu Yen in the south. The outbreaks started from Dec 17 to Jan 8, killing 1,509 of 11,830 birds. The country's H5N6 outbreaks are its first since July 2020.

Elsewhere in Asia, Tawian reported three more outbreaks involving H5N5 at commercial farms, two housing ducks and one raising geese. The outbreaks began from Dec 25 to Dec 31 in Pingung and Yunlin counties, killing 293 of 10,141 birds.

European countries, meanwhile, reported more H5N8 outbreaks. Poland reported two outbreaks, one at a duck farm in Kujawsko-Pomorskie province and one at a goose farm in Warminsko-Mazurskie province. The outbreaks started on Jan 5 and Jan 6, and, taken together, the virus killed 77 of 1,964 birds. In a separate report, Poland reported an event at a turkey farm in Lubuskie province that began on Jan 8, killing 123 of 15,600 poultry.

Germany reported eight more outbreaks, one at a layer farm in Mecklenburg-Vorpommern states and seven at mainly turkey farms in Lower Saxony state. The outbreaks began from Jan 1 to Jan 12, and among the events the virus killed about 300 of about 128,000 birds.

Finally, Hungary reported an H5N8 outbreak at a layer farm in Bacs-Kiskun County, which began on Jan 12, leading to the culling of 101,185 birds.
Jan 14 OIE report on H5N1 in Cambodia
Jan 14 OIE report on H5N6 in Vietnam
Jan 13 OIE report on H5N5 in Taiwan
Jan 13 OIE report on H5N8 in Poland
Jan 13 OIE report on H5N8 in Poland's Lubuskie province
Jan 13 OIE report on H5N8 in Germany's Mecklenburg-Valpommern state
Jan 13 OIE report on H5N8 in Germany's Lower Saxony state
Jan 14 OIE report on H5N8 in Hungary

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