Phase 2 study: Triple-drug COVID-19 therapy better than 2-drug regimen
A phase 2 trial has shown that a 2-week course of triple antiviral therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin is safe and better at shortening COVID-19 viral shedding than lopinavir-ritonavir alone in patients with mild to moderate illness if started within 7 days of symptom onset.
The prospective study, published late last week in The Lancet, involved 127 adult COVID-19 patients (mean age, 52 years) admitted to six Hong Kong hospitals from Feb 10 to Mar 20. Eighty-six patients were randomly assigned to receive 2 weeks of the triple-drug combination every 12 hours plus as many as three doses of injectable interferon beta-1b every other day, while 41 received lopinavir-ritonavir alone every 12 hours.
The researchers detected no live virus on nose-throat swabs within, on average, 7 days of starting the triple-drug combination, 5 days faster than with lopinavir-ritonavir alone (hazard ratio, 4.37; 95% confidence interval, 1.86 to 10.24; P = 0.0010). The combination treatment also halved the mean time to complete symptom relief (4 versus 8 days) and Sequential Organ Failure Assessment score of 0 (3 versus 8 days) and shortened the mean hospital stay from 14.5 to 9 days.
While patients who received the combination therapy within 7 days of symptom onset did better than those in the control group, there was no difference in outcomes when they were treated 7 or more days after symptoms began. The authors said that the results suggest that the triple combination may minimize the risk of antiviral resistance and decrease risks to healthcare workers by reducing the duration and quantity of viral shedding.
"Despite these encouraging findings, we must confirm in larger phase 3 trials that interferon beta-1b alone or in combination with other drugs is effective in patients with more severe illness (in whom the virus has had more time to replicate)," said lead author Kwok-Yung Yuen, MD, from the University of Hong Kong, in a Lancet news release.
May 8 Lancet study and news release
Chinese study shows COVID-19 RNA shed for up to 49 days
A new study published in Emerging Infectious Diseases shows that genetic material of SARS-CoV-2—the virus that causes COVID-19—was detected in body fluids from COVID-19 patients for up to 49 days.
The study was conducted in 49 patients from Guangdong, China, and assessed the presence of viral RNA in throat swabs, nasopharyngeal swabs, sputum samples, and feces specimens. Forty-three of the patients had mild cases of COVID-19, while 6 had severe cases. Researchers obtained specimens every 3 days for 4 weeks.
The authors found persistent shedding of virus RNA in both nasopharyngeal swab and feces samples.
"The estimated time until loss of virus RNA detection ranged from 45.6 days for nasopharyngeal swab samples to 46.3 days for feces samples in mild cases and from 48.9 days for nasopharyngeal swab samples to 49.4 days for feces samples in severe cases, which was longer than those of SARS-CoV and MERS-CoV," the authors wrote, referring to the coronaviruses that cause SARS and MERS, respectively.
The findings are consistent with published case reports, the authors concluded. They said their findings should inform diagnostic testing for COVID-19 and prevention measures.
May 8 Emerg Infect Dis study
H9N2 avian flu infects girl in China
China has reported one more illness from H9N2 avian flu, involving a 5-year-old girl from Hunan province, according to the monthly zoonotic flu report from the World Health Organization (WHO).
Her symptoms began on Apr 20, and she had a mild illness but was hospitalized and isolated on Apr 24. She was released from the hospital on Apr 30. An investigation revealed that the girl had been exposed to slaughtered poultry that were brought home from a live-bird market.
China had reported another similar case in early April, in a 3-year-old girl from Zhuhai in Guangdong province, who also had a mild illness and had contact with poultry. Both patients recovered. Their illnesses were found through flulike illness surveillance, and no other cases were found among their contacts.
The country has now reported 31 human H9N2 cases since 2015. The WHO said H9N2 is enzootic in Asian poultry and has been increasingly reported in Africa.
May 8 WHO monthly zoonotic flu update
Apr 8 CIDRAP News scan "China reports H9N2 avian flu in Guangdong province"
H5N6 and H5N1 avian flu strike poultry in Vietnam
Vietnam has reported more highly pathogenic H5N6 and H5N1 avian flu outbreaks in poultry, according to new notifications from the World Organization for Animal Health (OIE).
The country reported two new H5N6 outbreaks, one in Ninh Binh province and the other in Ha Noi province, both in the north, part of sporadic outbreak activity since early February. The outbreak in Ninh Binh began on Apr 14, and the event in Ha Noi started on May 6. Taken together, the virus killed 1,500 of 21,138 birds, and the rest were culled to curb the spread of the virus.
Also, the country reported three more H5N1 outbreaks in three provinces: Can Tho, Dong Thap, and Vinh Long, all involving village poultry in southern Vietnam. The outbreak began between Apr 16 and Apr 27, killing 2,160 of 3,070 susceptible birds. The remaining poultry were destroyed as part of the outbreak response. Vietnam's last H5N1 outbreak occurred in the middle of February.
May 10 OIE report on H5N6 in Vietnam
May 10 OIE report on H5N1 in Vietnam