COVID-19 survivors may be at higher risk of gastrointestinal disorders at 1 year

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HeartburnA study of more than 11.6 million people published today in Nature Communications suggests that COVID-19 survivors are at increased risk for a range of gastrointestinal disorders at 1 year.

Researchers from the Veterans Affairs Saint Louis Health Care System used their national healthcare database to compare the gastrointestinal outcomes of 154,068 COVID-19 survivors with those of 5,638,795 contemporary uninfected controls and 5,859,621 prepandemic controls.

At 1 year postinfection, COVID-19 patients were more likely than controls to have gastroesophageal reflux disease (hazard ratio [HR], 1.35; burden, 15.50 per 1,000 people), peptic ulcer disease (HR, 1.62; burden, 1.57), pancreatitis (HR, 1.46; burden, 0.6), functional dyspepsia (HR, 1.36; burden, 0.63), gastritis (HR, 1.47; burden, 0.47), irritable bowel syndrome (HR, 1.54; burden, 0.44), and cholangitis (HR, 2.02; burden, 0.22). The respective risk and burden of a composite of any diagnosis were 1.37 and 17.37.

Signs and symptoms were constipation, abdominal pain, diarrhea, vomiting, and bloating. The risk and burden of a composite of all signs and symptoms were 1.54 and 24.02, respectively.

Elevated risk with severe COVID-19

Compared with the contemporary control group, the risk of having any gastrointestinal outcome was elevated among COVID-19 patients (HR, 1.36; burden, 62.34), regardless of age, sex, race, and underlying medical conditions. The risks were also heightened relative to historical controls, and a comparative analysis suggested that hospitalized COVID-19 patients were at increased risk of severe gastrointestinal symptoms relative to those hospitalized with flu.

These rates may translate into large number of affected people.

While nonhospitalized patients were also at elevated risk, the likelihood of gastrointestinal disorders gradually rose along with COVID-19 severity, with the greatest risk among those who were hospitalized or admitted to an intensive care unit.

"Although the absolute burdens (expressed per 1000 persons at 1-year) may appear small, because of the large number of people with SARS-CoV-2 infection, these rates may translate into large number of affected people," the authors wrote. "This will have ramifications not only for the personal health of affected individuals, but also on health systems."

Quick takes: COVID testing for China travelers, pandemic readiness funds, UK booster plan

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  • The US government is finalizing a plan to ease COVID-19 testing requirements on travelers from China, a step that could be announced as soon as Mar 10, the Washington Post reported today, citing three unnamed sources. Though tensions between the United States and China are high due to security issues and the controversy over the origins of SARS-CoV-2, officials said the plan to unwind the testing policy is driven by public health priorities, not politics. The United States and other countries imposed the testing rule on travelers from China in late December owing to China's surge and concerns over the potential spread of new variants.
  • The World Bank has received an overwhelming response from low- and middle-income countries to its initial $300 million in pandemic preparedness funding, according to Reuters. More than 100 countries have put in early bids totaling at least $5.5 billion. The World Bank has raised $1.6 billion of an estimated pandemic funding gap of at least $10 billion.
  • UK vaccine advisers today announced a spring COVID-19 booster campaign for high-risk groups, including people ages 75 and older, nursing home residents, and people ages 5 and older who are immunosuppressed. The campaign is geared toward bridging the protection gap until the next round of boosters in the fall and is occurring amid widespread circulation and rising hospitalizations in older people.

Multidrug-resistant Mycobacteria outbreak linked to water purification system

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A study published today in the Annals of Internal Medicine suggests a multidrug-resistant bacteria outbreak that killed three hospital patients was likely linked to a commercial water purification system.

The study describes a Mycobacterium abscessus outbreak that occurred at Boston's Brigham and Women's Hospital from March 2017 to October 2017. The outbreak involved four cardiac surgery patients—two who had bloodstream infections, one with a left ventricular assist device driveline infection, and one with a sternal wound infection. All four patients were treated with multi-agent anti-mycobacterial regimens, and three died. Whole-genome sequencing of M abscessus isolates from the four patients suggested the infections were closely related.

Investigation into the source of the outbreak led researchers from Brigham and Women's and Harvard Medical School to obtain cultures from sinks and showers in each of the patient's rooms as well as two ice and water machines on the cardiac surgery intensive care unit and a step-down unit. The specimens from the ice machines were both positive for high concentrations of mycobacteria, as were two additional ice machines on the care patients' floor. Direct DNA extraction from ice and water machine samples found an exact match to a gene present in the outbreak samples.

Our cluster demonstrates the risk for unintended consequences associated with systems designed to improve hospital water.

Further investigation revealed that a commercial water purifier with charcoal filters and an ultraviolet irradiation unit that filtered water for one of the hospital's three inpatient towers was depleting chlorine levels, which may have allowed mycobacteria present in the municipal water system (which provides water to the hospital) to colonize that building's ice and water machines. The machines were removed, as was the water purification system, and no additional cases have since been reported.

"Our cluster demonstrates the risk for unintended consequences associated with systems designed to improve hospital water, the predilection of ice and water machines for microbial contamination and the risk this poses to patients, as well as the potential importance of augmenting hospitals' water management programs to monitor and prevent mycobacterial infections in addition to Legionella," the study authors wrote.

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