News Scan for Jan 27, 2021

News brief

Schizophrenia, but not mood or anxiety disorders, tied to COVID-19 death

COVID-19 patients diagnosed as having schizophrenia spectrum disorder—but not those with mood or anxiety disorders—were linked to an increased risk of death, according to an observational cohort study published today in JAMA Psychiatry.

Researchers at New York University (NYU) Langone Medical Center led the study, which involved monitoring adult COVID-19 patients with psychiatric conditions at their center from Mar 3 to May 31, 2020. Of the 7,348 patients, 75 (1.0%) had a schizophrenia spectrum disorder, 564 (7.7%) had a mood disorder, and 360 (4.9%) had an anxiety disorder.

After adjustment for demographic and medical risk factors, schizophrenia spectrum disorder was tied to an increased risk of COVID-19 death (odds ratio [OR], 2.67). However, mood disorders and anxiety disorders weren't associated with death (OR, 1.14 and 0.96, respectively). Schizophrenia spectrum disorder was outranked only by age as a risk factor for coronavirus-related death.

Of the 7,348 patients, 864 (11.8%) died or were released to hospice within 45 days of a positive coronavirus test result.

The authors noted that at least two US cohort studies have identified a link between COVID-19 infection risk and depression and schizophrenia, which they said could be caused by biological factors related to psychiatric disorders (eg, impaired immune function) or socioeconomic and environmental factors such as crowded living conditions, congregate care settings, and lack of personal protective equipment.

"Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of COVID-19," said lead author Katlyn Nemani, MD, with NYU Langone Health, in a university news release. "With this newfound understanding, health care providers can better prioritize vaccine distribution, testing, and medical care for this group."
Jan 27 JAMA Psychiatry study
Jan 27 NYU Langone Health news release


COVID-19 outbreaks associated with summer camp, high school wrestling

COVID-19 outbreaks at an overnight camp in Georgia and a high school wrestling tournament in Florida last year involved attack rates of at least 56% and 30%, respectively.

Yesterday researchers in Pediatrics detailed the summer camp outbreak, noting that, of 627 staff, trainees (who left before camp officially began), and campers, 12 community-associated COVID infections (1.9%) led to 339 camp-associated infections (54.1%). The mean effective case reproduction number, or the number of secondary people infected per case, was as high as 4.0 during orientation, and instantaneous reproduction peaked at 10.0 the first day all the campers arrived.

From Jun 17-20, 2020, staff and trainees attended orientation, and the camp ran from Jun 21 through 27. Pre-arrival COVID test results were mandated, and while cabin cohorts were created to reduce potential transmissions, mask usage was not enforced. Follow-up interviews revealed that 88% of attendees were still in close or direct contact with people outside their cohorts and that only 15% of trainees and staff and 5% of campers wore masks all the time.

No cases involved hospitalization. "Testing should not be used as the sole mitigation measure," the investigators write.

The 2-day wrestling tournament, meanwhile, was linked to 79 total cases, according to yesterday's Morbidity and Mortality Weekly Report. The first case, from a school in "County A," was reported to local public health officials on Dec 7, 2020, 2 days after the tournament ended. The 130 event attendees included wrestlers, coaches, and referees across 10 high schools and three counties.

Thirty-eight cases were directly linked to the event, with 70.4% of 54 tests coming back positive. Out of 446 close contacts from households and schools, 95 (21.3%) received testing, revealing 41 additional cases. Secondary cases were most common among household members (60.0% of tested close contacts) and wrestlers who were not at the tournament (54.2%). The minimum attack rate (percent of those infected) was 30.2%

The investigators calculated that approximately 1,700 in-person school days were lost because of quarantine and sickness, which was lower than it could have been because of the proximity to the end of the semester. After the outbreak was detected, all winter high school sports in County A were suspended. One adult above age 50 died, but the report did not list the cause.
Jan 26 Pediatrics study
Jan 26 MMWR study


Strategies noted to address HPV vaccine shortages in low-resource areas

Amid a shortage of human papillomavirus (HPV) vaccines that Gavi, the Vaccine Alliance, provides to low- and middle-income countries, scientists implementing Tanzania's national vaccination program highlight difficulties in outreach and tracking that were caused or exacerbated by the lack of vaccines, according to a commentary yesterday in Vaccine.

Because of a shortage of the two-dose quadrivalent (four-strain) HPV vaccine, the Tanzania government was not able to target all girls ages 9 to 14 for its national HPV vaccine program, which is what the World Health Organization recommends. Instead, the 2018 program began by 14-year-old girls to promote equity and maximum coverage, as 15-year-old girls were not eligible. The only exception was the Kilimanjaro region, where a prior pilot program targeting 9-year-old girls had begun in 2014.

The administration integrated vaccine campaigns into routine delivery strategy with fixed health facilities, outreach sites, and school sites, but because 14-year-old girls were in primary school, secondary school (often moving locations for enrollment), or out of school, the administration has had to expend more human resources and finances than expected.

By the end of 2019, coverage of the first HPV vaccine dose was 78%, but second-dose coverage was only 49%.

Tanzania expected to be able to switch to a multiple-age cohort within 2 years of the program's start and then again to solely target 9-year-old girls across the country, but the lack of supply has made this impossible. Currently the HPV vaccine shortage for low- and middle-income countries is expected to last at least to 2024 because of a mismatch of supply and demand, even as 16 additional countries are expected to start HPV national campaigns by 2022. 

"Given their country situation," the authors write, "decision-makers will need to balance equity concerns with the feasibility of reaching the selected target population and achieving high vaccination coverage."

"While additional vaccine manufacturers and single-dose vaccination strategies might relieve the supply constraints in the future, country programs and the global community must work together now to align efforts," they add.
Jan 26 Vaccine study

Stewardship / Resistance Scan for Jan 27, 2021

News brief

Groups criticize One Health Certified food label over antibiotic use standards

A coalition of animal welfare, public health, environmental, and consumer organizations is speaking out against use of the One Health Certified (OHC) label on chicken and turkey products, claiming the standards behind the label don't protect against overuse of medically important antibiotics in food-producing animals.

The OHC program is open to food producers who want to demonstrate to consumers a commitment to responsible, sustainable, and transparent animal care practices. Responsible antibiotic use in livestock is listed as one of the core principles of the OHC program, which links itself to the concept that human, animal, and environmental health are inextricably linked.

But in a press release yesterday, the coalition of 13 organizations said the OHC standards are weaker than and out of line with the responsible antibiotic use practices recommended by the World Health Organization (WHO) in 2017, and are less stringent than those already adopted by the US poultry industry.

In particular, the groups note that OHC standards allow the use of medically important antibiotics for disease prevention in animals, rather than reserving them for treating sick animals or controlling disease outbreaks on farms. The WHO guidelines recommend against using medically important antibiotics for disease prevention in food-producing animals, and many public health and antibiotic-resistance experts believe the practice contributes to the emergence and spread of resistant bacteria.

"Antibiotic resistance is one of the greatest threats to public health today and overuse of antibiotics in animal agriculture is one of the driving forces behind this crisis," said Laura Rogers, deputy director for the Antibiotic Resistance Action Center at George Washington University's Milken Institute School of Public Health. "Genuinely responsible use of antibiotics needs to be addressed in conjunction with improved animal health and welfare practices to decrease disease risks and minimize the need for antibiotics in the first place."

The groups also say the OHC standards on animal welfare and environmental protection are lacking.

The OHC label was approved in early 2020 and is currently being used by a handful of grocery chains.
Jan 26 Coalition press release


CARB-X to fund development of low-cost diarrheal disease treatment

CARB-X announced today that it is awarding up to $5.35 million to Lumen Bioscience of Seattle to develop a new immunotherapy to prevent diarrheal diseases caused by Campylobacter jejuni and enterotoxigenic Escherichia coli

The money will help fund development of LMN-GI-EEC-401, an oral antibiotic-alternative biologic designed to bind to and neutralize C jejuni and enterotoxigenic E coli, the two primary causes of what is commonly known as traveler's diarrhea. In low- and middle-income countries, diarrheal diseases are a leading cause of death and disease among infants and children.

Lumen says the goal is to develop a cheap, edible, immuno-prophylactic drug that could be distributed in areas of the world where healthcare temperature control is not available.

"Preventatives are urgently needed for deadly infections," CARB-X research and development chief Erin Duffy, PhD, said in a press release. "The Lumen project is an extremely innovative immunotherapy in the early phases of development, and if successful, could potentially transform the way we prevent deadly infections in infants and children, and save precious lives."

The project could be eligible for up to $8.26 million more in non-dilutive funding from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) if certain project milestones are met.
Jan 27 CARB-X press release

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