News Scan for Jan 19, 2021

News brief

Many US immigration detention centers rife with COVID-19 cases

COVID-19 infection rates in US Immigration and Customs Enforcement (ICE) detention centers are higher than those in the general population and eclipse those of surrounding communities, according to a research letter published today in JAMA Network Open.

The authors, led by a researcher from the University of Miami in Florida, analyzed data from the COVID Prison Project, the New York Times, and the American Community Survey from May 5 to Sep 15, 2020.

There were 167 detention facilities housing people detained by ICE, the majority of which housed mostly non-ICE detainees (eg, county jails). ICE officials reported at least one COVID-19 case in each of 96 facilities. Twenty-eight ICE facilities, including four family residential centers, housed only ICE detainees.

According to the ICE mean daily population, the overall coronavirus case rate as of Sep 15 was 5,810 per 27,189 people (214 per 1,000).

COVID-19 case rates increased, and test positivity rates declined, with more testing. But case rates among ICE detainees have grown faster than those of the US population, with the total case rate in the 28 ICE facilities ranging from 0 to 1,050 per 1,000 people. In 20 of the facilities, the risk ratio for infection was greater than 1, indicating increased risk.

Because the study relied on ICE case reporting, the authors said that the actual rates of infection may be higher than indicated in their findings. They noted that ICE facilities have been described as unsanitary, unsafe, and inhumane, with moldy bathrooms and limited personal hygiene supplies and medical services—all of which pose health risks even in a nonpandemic setting.

Ongoing deportation flights have led to confirmed spread of COVID-19 in more than 11 countries, the authors said. "Ultimately, it is imperative that expeditious action is taken to protect people housed in ICE detention facilities from COVID-19 by reducing the number of people detained and terminating raids, transfers, and deportation flights," they wrote.
Jan 19 JAMA Netw Open research letter

Kids, teens may be less likely to get COVID but more likely to spread it

An observational study published yesterday in The Lancet Infectious Diseases suggests that children and teens in Wuhan, China, homes were less vulnerable than older household contacts to COVID-19 infections but were more likely to spread the virus.

A team led by researchers from the Wuhan Center for Disease Control and Prevention studied the 27,101 households of all 29,578 confirmed COVID-19 patients and their 57,581 household contacts in Wuhan from Dec 2, 2019, to Apr 18, 2020. Of the household contacts, 10,367 tested positive for COVID-19, 29,658 tested negative, and 17,556 weren't tested.

Using a transmission model that assumed a mean incubation period of 5 days and an infectious period of no more than 22 days, the authors estimated that 15.6% of household members became infected.

Household members 60 years and older were more likely to be infected than younger ones. Among children, those 0 to 1 years were at much higher risk for COVID-19 infection than those 2 to 5 years (odds ratio [OR], 2.20) and 6 to 12 years (OR, 1.53).

Compared with adults 60 years and older with the same virus exposure time, children younger than 20 were more likely to infect others (OR, 1.58). Household members diagnosed as having COVID-19 but with no symptoms were significantly less likely to infect others than those who had symptoms (OR, 0.21). And those with symptoms were most likely to spread the virus to others before their symptoms began than after (OR, 1.42).

Household members infected by an index patient had more asymptomatic cases (4.2% vs 1.9%) and fewer severe or critical cases of COVID-19 (13.9% vs 19.2%). Children and teens were substantially less likely to have severe disease than those 60 years and older (2.4% vs 18.8%).

After efforts to isolate COVID-19 patients, quarantine household contacts, and restrict movement began, the mean number of people each COVID-positive person infected fell by 52% in primary contacts and 63% in secondary contacts.

"The relatively high infectivity of children in households should be considered carefully when making decisions around school reopenings, as infected children can pass the virus to their family members," the authors wrote.
Jan 18 Lancet Infect Dis study

Flu vaccine effectiveness may fall 8% to 9% monthly after immunization

Flu vaccine effectiveness (VE) in adults waned 8% to 9% each month after vaccination, a study of the 2015-2016 to 2018-2019 US flu seasons finds.

The study, led by researchers from the Centers for Disease Control and Prevention and published today in Clinical Infectious Diseases, analyzed electronic medical records and interviews from participants in the US Hospitalized Adult Influenza Vaccine Effectiveness Network.

The investigators found that vaccines were maximally effective shortly after vaccination, with subsequent monthly declines in their effectiveness for preventing hospitalizations related to flu among 3,016 patients.

Adjusted VE against flu-related hospitalizations decreased with increasing time since vaccination, with mean declines of 7.5% per month for the H3N2 strain, 8.5% for H1N1, and 8.0% for influenza B. In adults 65 years and older, VE against flu-related hospitalizations declined more quickly, at 10.8% per month for H3N2, 9.6% for H1N1, and 10.8% for influenza B.

Of all vaccinees, 34% had received their vaccination by the end of September, while 77% had theirs by the end of October, 92% by the end of November, and 97% by the end of December.

While the optimal timing of flu vaccination for the best flu season coverage remains under debate, current US guidelines recommend that vaccination take place by the end of October.

The authors noted that their results support those of earlier studies showing that antibodies against flu fell by about a third 4 to 5 months after vaccination.

"The public health implications of these findings warrant closer examination because even a 1-2 month delay in annual vaccination could improve VE by 10 to 20%," the researchers concluded. "If such an approach does not encroach on the annual influenza season, delay vaccine delivery, or reduce vaccine uptake, it could lead to appreciable gains in public health benefits given the large burden of influenza morbidity and mortality annually in the US."
Jan 19 Clin Infect Dis study

More H5N1 and H5N8 avian flu hits poultry in Asia and Europe

In the latest highly pathogenic avian flu developments in poultry, India and Vietnam reported more H5N1 outbreaks and South Korea and European nations reported more events involving H5N8, according to the latest notification from the World Organization for Animal Health (OIE).

India reported an H5N1 outbreak at a farm in the west central state of Madhya Pradesh that began on Jan 6, killing 127 of 1,053 birds. It also reported an outbreak in backyard birds in Maharashtra state in the south central part of the country, which started on Jan 7 and killed 843 of 4,286 birds. In both instances, the source of the virus isn't known.

Elsewhere, Vietnam reported six more H5N1 outbreaks in village birds, affecting four southern provinces: Soc Trang, Bac Lieu, Tien Giang, and Long An. The events began from Aug 20 to Dec 31, and, taken together, the virus killed 684 of 8,704 birds.

Meanwhile, countries on two continents reported more H5N8 outbreaks. India said the virus struck two commercial farms in Haryana state in the north, which began on Jan 2, killing 16,000 of 168,821 susceptible birds between the two events. It also reported an outbreak in backyard birds in Maharashtra state. The source of the virus isn't known for any of the outbreaks.

South Korea reported 15 more H5N8 outbreaks in seven provinces: South Jeolla, North Jeolla, Gyeonggi, South Gyeongsang, North Gyeongsang, South Chungcheong, and North Chungcheong. The events began from Jan 7 to Jan 16, and among all the outbreaks, the virus killed 983 of 1,168,500 birds.

In Europe, France reported 76 more outbreaks, mostly in ducks from already affected Landes department in the southwest. The outbreaks began from Dec 26 to Jan 11, leading to the deaths of 93,83 of 366,016 birds. Germany, Russia, and Poland also reported more H5N8 outbreaks in poultry, with Germany's events occurring in Lower Saxony state, Poland's in Kujawsko-Pomorskie and Zachodnio-Pomorskie provinces, and Russia's in Krasnodar Krai. Also, Ukrainian officials reported an H5 outbreak in backyard birds in Nikolayev oblast that began on Jan 14, killing 9 of 16 birds.
Jan 18 OIE report on H5N1 in India's Madhya Pradesh state
Jan 18 OIE report on H5N1 in India's Maharashtra state
Jan 17 OIE report on H5N1 in Vietnam
Jan 18 OIE report on H5N8 in India
Jan 19 OIE report on H5N8 in South Korea
Jan 18 OIE report on H5N8 in France
Jan 15 OIE report on H5N8 in Germany
Jan 19 OIE report on H5N8 in Poland
Jan 19 OIE report on H5N8 in Poland
Jan 18 OIE report on H5N8 in Russia
Jan 16 OIE report on H5 in Ukraine

Stewardship / Resistance Scan for Jan 19, 2021

News brief

University of Oxford to launch new AMR research institute

The University of Oxford announced today that it has received £100 million ($136 million USD) from the chemical manufacturing company Ineos to launch a new institute to study antimicrobial resistance (AMR).

The Ineos Oxford Institute for AMR Research will focus primarily on developing new antimicrobial drugs, particularly novel drugs just for animals. Scientists at the institute will also contribute to research on the type and extent of drug-resistant microbes across the world, and promote responsible use of antimicrobials in human and animal medicine.

"Just as the discovery of penicillin and subsequent antibiotics transformed modern medicine, the rapid and relentless growth of antimicrobial resistance poses one of the most serious threats to human life worldwide," Oxford professor of medical microbiology Tim Walsh, PhD, said in a university press release.

"Modern agriculture and healthcare both heavily reliant on antibiotics, which is why it is vital to address this issue as a humanitarian emergency and to bring together national and international expertise across scientific disciplines to develop new drugs and policies to tackle this global problem."

The institute will be based in the University of Oxford's departments of chemistry and zoology.
Jan 19 University of Oxford press release

Intense stewardship, infection control tied to less antibiotic ICU use

Implementation of intensive antimicrobial stewardship strategies and monitoring of infection prevention and control practices were associated with a reduction in antibiotic use in the surgical intensive care unit (ICU) of an Indian hospital, researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

The study, conducted by researchers with the Postgraduate Institute of Medical Education and Research in Chandigarh, India, compared antibiotic use in the hospital's ICU surgical recovery unit from April 2017 to June 2017 (the baseline period) with antibiotic use from July 2017 to December 2017 (the intervention period).

During the baseline period, routine prospective audit and feedback of antibiotic prescribing was conducted, per the hospital's antimicrobial stewardship program. For the intervention period, additional stewardship interventions, including antibiotic timeouts, dose optimization, and small training sessions on rational antibiotic use were implemented, along with a bundle of measures for preventing healthcare-acquired infections.

A total of 337 patients were included in the study, with 94 observed in the baseline phase and 243 in the intervention phase. Comparison of the two periods showed a decrease in the days of therapy per 1,000 patient-days (1,112.3 days in the baseline period vs 1,048.6 days in the intervention period) and the length of therapy per 1,000 patient-days (956 vs 936.3 days). The cumulative defined daily doses per 1,000 patient-days for all antimicrobials also fell (1,326.3 vs 1,313.5). Double cover for gram-negative infections was noted in 9.5% of total patients in the baseline phase, compared with 2.9% of patients in the intervention phase.

The analysis also found that the incidence of ventilator-associated pneumonia per 1,000 ventilator-days declined from 46.4 to 35.4, while central line–associated bloodstream infections per 1,000 central line–days remained the same (14.7 vs 14.8).

The authors of the study say the findings, though limited, could be applicable to ICU surgical recovery units in other developing countries with limited resources.
Jan 18 J Glob Antimicrob Resist study