Adult COVID-19 patients exposed to air pollution spent an average of 4 extra days in the hospital, further overwhelming health systems, concludes a Belgian study published yesterday in the European Respiratory Journal.

For the study, experts collected blood and urine from 328 unvaccinated COVID-19 patients admitted to one of two hospitals in Belgium from May 2020 to March 2021, 29% of whom required intensive care. The team modeled daily exposures to particulate matter (PM), nitrogen dioxide (NO₂), and black carbon (BC) from 2016 to 2019 and measured BC particles in the blood using pulsed laser illumination.

Patients diagnosed as having COVID-19 from May 2020 to mid-February 2021 were infected with the wild-type virus, while most patients recruited from mid-February 2021 to March 2021 were infected with the Alpha variant. Average age was 65.7 years, and 43.6% were women.

Pollution equivalent to being 10 years older

All levels of exposure were below the European Union pollution threshold. The average hospital length of stay was 16.9 days. An interquartile range (IQR) increase in exposure in the week before hospitalization was tied to a roughly 4-day longer stay (4.2 days for PM and 4.3 days for NO₂. Comparable findings were seen for long-term NO₂ and BC exposure.

The effects of pollution on hospital length of stay were equivalent to the effect of a 10-year increase in age, and an IQR rise in blood BC concentrations increased the likelihood of requiring intensive care by 36%.

People who were exposed to air pollution, even at relatively low levels, were sicker and needed more time in hospital to recover.

Each 10-year increase in age correlated with an extra 2.4 days of hospitalization, and men were hospitalized for an average of 4.0 days longer than women. Conversely, reducing pollution exposure was an estimated 40% to 80% as effective in shortening hospitalization as some of the best available treatments.

"Our findings indicate that people who were exposed to air pollution, even at relatively low levels, were sicker and needed more time in hospital to recover," senior author Tim Nawrot, PhD, of Hasselt University, said in a European Respiratory Society press release.

The World Health Organization (WHO) today announced that it has certified Belize as free of malaria, a culmination of a more than 70-year effort to stamp out the disease.

In its announcement, the WHO said Belize went from a peak of 10,000 cases in 1994 to 0 indigenous cases in 2019. It said the country took strategic steps to dramatically reduce its malaria burden, which included strong surveillance and vector control, which in 2015 were reoriented to focus on high-risk areas. The agency also added that trained health workers have played a key role in timely diagnosis and treatment.

This is an extra-ordinary achievement for Belize.

Jarbas Barbosa, MD, PhD, MPH, director of the WHO's Pan American Health Organization (PAHO), said Belize is the fourth country in the Americas to be certified as malaria-free and is the second in Central America to achieve the status in the past 5 years.

"This is an extra-ordinary achievement for Belize, and will also serve as inspiration for the other endemic countries in the Americas," he said. To be certified as free of malaria, a country must provide strong evidence that the chain of transmission from Anopheles mosquitoes has been interrupted nationwide for 3 consecutive years.

Possible El Nino impact on mosquito-borne illness

In related news, at a WHO media briefing on a host of global health issued today, Director-General Tedros Adhanom Ghebreyesus, PhD, said Peru is battling its worst dengue outbreak, with about 150,000 suspected cases so far, about half of them lab-confirmed. Peru has declared a state of emergency, and the outbreak has put a heavy burden on the country's health system.

Tedros said the WHO is preparing for a very high probability that 2023 and 2024 will be marked by an El Nino event, which could increase the transmission of dengue and other arboviruses such as Zika and chikungunya viruses. He added that the effects of climate change are also fueling mosquito breeding and the spread of mosquito-borne viruses.

A study of soil samples collected in a remote region of China has revealed the presence of a drug-resistant pathogenic fungus, researchers reported today in mSphere.

For the study, a team of researchers from Yunnan University in China and McMaster University in Canada collected soil samples from the Three Parallel Rivers region in

Yunnan, China, a remote and sparsely populated area that's home to more than 4,000 fungal species. They were looking to investigate the population structure and resistance levels of Aspergillus fumigatus, a ubiquitous mold and common human fungal pathogen.

Previous research by the team had found that 79% of A fumigatus samples from Yunnan greenhouses were resistant to commonly used antifungal drugs, while 15% of samples from agricultural fields, lake sediments, and forests in the region were resistant. Those findings were attributed to widespread use of agricultural fungicides.

Fungicide residues may have carried

In the present study, the researchers found that 6.95% of 331 representative A fumigatus isolates collected from 19 sites along the three rivers in January 2020 were resistant to one or both of two triazole antifungals—itraconazole and voriconazole. While that's much lower than observed in the two previous studies, the authors note that the mountainous terrain in the region is unfavorable to agricultural activities, and the use of fungicides is uncommon.

They suggest that fungicide residues from agricultural fields elsewhere in Yunnan may have been carried to non-agriculture soils, where they acted as a selective force for the emergence of resistance. Or that resistant spores from agricultural areas could have been carried to the region by wind or human activities.

These drug-resistant strains are capable of propagating very quickly and taking over local and regional populations of this species.

"Seven per cent may seem like only a small number, but these drug-resistant strains are capable of propagating very quickly and taking over local and regional populations of this species," study coauthor Jianping Xu, PhD, a professor of biology at McMaster University, said in a university press release. "There is a need for increased surveillance of drug resistance in the environment across diverse geographic regions."

Xu says future research will analyze fungal spores from air samples in the region to better understand how fungal resistance spreads.

A systematic review of studies on neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) infections indicates the pathogen is emerging as a severe threat to hospitalized newborns, particularly those in low- and middle-income countries (LMICs), researchers reported yesterday in PLOS Medicine.

The review by UK and Chinese researchers included 128 studies involving 127,583 neonates in 30 countries, including 21 LMICs, and documented 2,057 CRKP isolates collected from infected or colonized infants from 2005 to 2020. The most common sample type from infected newborns was blood (37.3%), suggesting that bloodstream infection is the main type of neonatal CRKP infection.

Among the 23 studies that reported on prevalence, the pooled prevalence of CRKP infection in hospitalized newborns was 0.3% (95% confidence interval [CI], 0.2% to 0.3%), with a significantly higher prevalence observed in Asian countries (0.7%; 95% CI, 0.4% to 1.0%) than African countries (0.3%; 95% CI, 0.1% to 0.4%). Among the 21 studies that reported on outcomes, the pooled mortality was 22.9% (95% CI, 13.0% to 32.9%).

Analysis of 535 neonatal CRKP genomes identified 146 sequence types (STs) for CRKP strains and found that ST17, ST11, and ST15 were the three most common, with ST17 documented in newborns in eight countries across four continents. Most neonatal CRKP strains (75%) carried a metallo-beta-lacatamase (MBL) gene, with New Delhi metallo-beta-lactamase the most common (64.3%) carbapenemase type, which suggests that treatment options for many neonatal CRKP infections could be limited.

Substantial global burden

The study authors say the findings indicate that neonatal CRKP infections poses a significant health burden worldwide.

"Global data on neonatal admissions are not available, but when considering these early or premature neonates only, there could be at least 60,000 estimated cases of neonatal CRKP infections with at least 5,880 estimated deaths worldwide," they wrote.

There could be at least 60,000 estimated cases of neonatal CRKP infections with at least 5,880 estimated deaths worldwide.