People with immune impairment accounted for 22% of COVID hospital stays, deaths, study suggests

News brief

Immunocompromised man in hospital bed — *Evgeniy Shkolenko / iStock*

People with weakened immune systems—most of whom were vaccinated—made up 4% of a random sample of more than 12 million people in England in 2023 yet represented 22% of both COVID-19 hospital admissions and deaths, according to new findings from the INvestigation oF cOvid-19 Risk among iMmunocompromised populations (INFORM) study.

European researchers and representatives from the pharmaceutical company AstraZeneca conducted a retrospective study using the electronic health records of participants aged 12 years and older from a random 25% sample of the English population from January to December 2023.

The results were published in the Journal of Infection.

Twice the risk of hospitalization

Over the study period, 11,200 COVID-19 hospitalizations and 2,330 deaths occurred in the study sample. Immunocompromised participants accounted for 4.0% of 12.1 million people included in the sample but made up 21.7% and 21.9% of COVID-19 hospitalizations and deaths, respectively.

Beyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination.

The risk of severe COVID-19 was higher among immunocompromised than otherwise healthy people (adjusted incidence rate ratio [aIRR] for hospitalization, 2.04; aIRR for death, 1.69).

Immunocompromised participants were more likely to have received at least four doses of COVID-19 vaccine than their non-immunocompromised peers (72.6% vs. 29.8%). The aIRRs for COVID-related consultations with a general practitioner and accident and emergency visits were 2.26 and 3.02 for immunocompromised and non-immunocompromised people, respectively.

Of the immunocompromised subgroups, the risk of COVID-19 hospital admission was highest for recipients of a stem cell transplant in the 2 years before infection (aIRR, 19.18), followed by those who had a solid organ transplant in the 5 years before infection (aIRR, 6.53). Other groups with a threefold or higher risk than those without the immune-weakening condition included those with primary immunodeficiency, end-stage kidney disease or dialysis, or blood cancers.

"Beyond three years since the start of the COVID-19 pandemic, immunocompromised individuals remain disproportionately impacted from COVID-19 despite increased vaccination," the authors wrote. "These findings highlight a persistent need for additional COVID-19 interventions for immunocompromised populations."

Uganda Ebola Sudan outbreak total rises to 9 cases

News brief

Lisa Schnirring

Two more illnesses have been reported in Uganda's Ebola Sudan outbreak, raising the outbreak total to nine, according to a weekly infectious disease update from the Africa Centres for Disease Control and Prevention (Africa CDC). The agency based its numbers on information from Uganda's health ministry.

So far, the death total remains at one, putting the case-fatality rate at 11.1% Uganda is battling its first Ebola Sudan outbreak since 2022, with clusters reported in the family of the index patient—a male nurse who died in the middle of January—and another connected to a healthcare facility.

The first patient's symptoms began on January 19, and he died 10 days later. The man had visited a traditional healer and three separate health clinics before he died in Kampala, all factors that pose a risk of further spread.

H9N2 avian flu infects 2 more in China

News brief

Lisa Schnirring

China has reported two more H9N2 avian flu infections in humans, both of them patients from Hunan province in the southern part of the country, according to a weekly avian flu update today from the Hong Kong Centre for Health Protection (CHP).

backyard poultry — *Alesia Davydava/iStock*

One of the patients is a 2-year-old boy whose symptoms began on December 27, which would raise the total for 2024 to 18.

The second patient is a 15-year-old boy whose symptoms began on January 8, which would mark the first H9N2 case of the new year.

The CHP report didn't say how the patients were exposed to the virus, though H9N2 infections are sporadically reported in people who have contact with poultry. H9N2 is known to circulate in poultry across parts of Asia, including China.

Illnesses in people are often mild and reported in children.

CEPI awards $5 million to company developing nasal RNA vaccines

News brief

Stephanie Soucheray, MA

Today the Coalition for Epidemic Preparedness Innovations (CEPI) announced an award of $5 million funding award to Ethris, a German biotechnology firm working on next-generation RNA vaccines.

The award will help Ethris develop spray-dried RNA vaccines that remain stable at room temperature and are suitable for nasal delivery, CEPI said in a press release.

The vaccines would use spray-drying technology—the same as used in asthma inhalers—that rapidly dries liquid with hot gas to form stable powders for respiratory delivery via the nose. CEPI said the nasal administration could help to achieve mucosal immunity, a key for reducing virus transmission.

Spray-drying for RNA-based vaccines could make them more practical and accessible similar to the established standards in respiratory medicine.

"Spray-drying for RNA-based vaccines could make them more practical and accessible similar to the established standards in respiratory medicine," said Christian Plank, PhD, chief technology officer at Ethris. "With CEPI's support, we aim to demonstrate the feasibility of spray-drying for RNA formulations, enabling vaccines to remain stable at room temperature while allowing for simpler, needle-free administration. If successful, this approach has the potential to transform vaccine delivery and accessibility on a global scale."

No need for cold storage

Importantly, spray-dry vaccines would eliminate the need for cold-chain storage, a logistical problem in many low-resource countries. Both mRNA vaccines used for COVID-19 require cold storage across the supply chain.

"If successful, this method would enhance access to RNA-based vaccines by increasing their thermostability and offering an alternative for individuals with needle phobia," said Raafat Fahim, PhD, the interim executive director of manufacturing and supply chain at CEPI.

CARB-X funds rapid test to detect pneumonia from urine samples

News brief

Chris Dall, MA

CARB-X (Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) today announced an award of $1 million to Pearl Diagnostics to develop a low-cost, rapid test to diagnose pneumonia caused by Pseudomonas aeruginosa from urine samples.

The award from the latest round of CARB-X funding will help the company evaluate the potential of a prototype assay that can detect microbial extracellular vesicles excreted in urine by organisms in the lungs. Pearl has used the technology to develop a urine test that can detect lower respiratory tract infections caused by Aspergillus fungi.

Pneumonia is a leading cause of illness and death worldwide, particularly in people with compromised immune systems. The lack of rapid, non-invasive diagnostics for detecting the causative pathogen in pneumonia patients frequently leads to overuse of broad-spectrum antibiotics.

Test could enable more targeted antibiotic treatment.

CARB-X officials say early detection of pneumonia caused by P aeruginosa, which has developed resistance to several classes of antibiotics and frequently causes hospital-acquired and community-associated infections in immunocompromised people, could help clinicians quickly target appropriate antibiotic treatment.

"Pearl Diagnostics' innovative prototype assay has the potential to offer a groundbreaking approach to early, accurate, and non-invasive diagnosis of lower-respiratory-tract infections," CARB-X research and development chief Erin Duffy, PhD, said in a CARB-X press release. "The ability to detect such infections through urine, especially for patients with compromised immune systems, could significantly shift the way we diagnose and manage these multidrug-resistant infections, enabling more targeted treatments and better patient outcomes."

"Pearl Diagnostics' Smart Antibody technology represents a paradigm shift in diagnosing lung infections," said Pearl Diagnostics CEO DeWayne Davenport. "We're excited about the potential impact our Pseudomonas aeruginosa test will have on patient outcomes and healthcare globally."

Demonstrating proof of concept for diagnosing lower respiratory tract infections from novel sample types is one of the distinct product themes in CARB-X's 2024 funding round. Since its founding in 2016, CARB-X has funded 113 early-stage projects designed to prevent, diagnose, and treat antibiotic-resistant infections.