News Scan for Aug 18, 2020

News brief

Ebola infects 1 more in the DRC; outbreak total at 89 cases, 37 deaths

One more Ebola illness and one more death from the virus have been confirmed in the Democratic Republic of the Congo (DRC) Equateur province outbreak, the World Health Organization (WHO) African regional office said on Twitter today.

The new developments push the outbreak total to 89 cases and 37 deaths.

In its latest weekly outbreaks and health emergencies report, the WHO regional office said a healthcare worker strike was occurring in some of the affected area, including the provincial capital, Mbandaka. WHO sources and other officials said a 3-day strike over unpaid wages ended yesterday, according to Reuters.

The WHO update also said five patients with confirmed Ebola infections remain in the community, posing a risk of further spread. It also noted that 30 health areas have now reported cases, though 3 have gone without a case for 42 days.
Aug 18 WHO African regional office tweet
Aug 18 WHO African regional office weekly report
Aug 17 Reuters story

California reports first human plague case in 5 years

The California Department of Public Health said that a resident in South Lake Tahoe has the first confirmed case of human plague in 5 years in the state. The resident, an avid walker, was likely bit by a flea while walking a dog near the Truckee River Corridor, in El Dorado County.

"Plague is naturally present in many parts of California, including higher elevation areas of El Dorado County," said El Dorado County Public Health Officer Nancy Williams, MD, in a press release. "It's important that individuals take precautions for themselves and their pets when outdoors, especially while walking, hiking and/or camping in areas where wild rodents are present. Human cases of plague are extremely rare but can be very serious."

From 2016 through 2019, El Dorado County officials found 20 ground squirrels and chipmunks with evidence of the plague bacterium, Yersinia pestis, but there were no reports of human illnesses during that time. Plague symptoms can take up to 2 weeks to develop in people, and infections can be fatal if not treated with antibiotics.

According to the El Dorado County Health and Human Services Agency, the last human cases of plague in California occurred in 2015 after two people were exposed to infected rodents or their fleas in Yosemite National Park. Before that, the state had not had a confirmed case since 2006.
Aug 17 El Dorado County press release

Citywide school flu vaccination program tied to community benefits

A multiyear school influenza vaccine intervention in Oakland was associated with decreased flu-related hospitalizations in all ages and a reduction in school absences due to illness, researchers reported today in PLOS Medicine.

For the study, researchers at the University of California, Berkeley; University of California, San Francisco; and the California Emerging Infections Program evaluated a citywide school-located influenza vaccination (SLIV) intervention implemented at more than 95 preschools and elementary schools in Oakland from 2014 to 2018. Using a matched cohort design that compared schools included in the intervention with schools in a nearby district that were not included, they estimated the impacts of the intervention on student flu vaccine coverage, lab-confirmed community-wide flu hospitalizations, and school absenteeism.

The results of the analysis showed that flu vaccine coverage was similar between the intervention and the comparison districts during the 2014-15 and 2015-16 flu seasons, when the vaccine had low effectiveness, but was 7% higher in the intervention schools in 2016-17 and 11% higher in 2017-18, when the vaccine was moderately effective.

After accounting for pre-intervention differences in hospitalizations in both districts, the SLIV program was associated with a decrease of 17 flu hospitalizations per 100,000 among non–elementary-school-aged people in 2016-17 and 73 hospitalizations per 100,000 among adults 65 and older. During the 2017-18 season, flu hospitalization rates fell by 37 per 100,000 among non–elementary-school-aged people and by 160 per 100,000 among those 65 and older.

The SLIV intervention was also associated with a reduction of 0.63 in the rate of illness-specific school absences per 100 school days in 2016-17 and 0.80 in 2017-18.

"Our findings suggest that even moderate increases in influenza vaccination above modest coverage levels are associated with broad community-wide benefits," the authors concluded.

Among the limitations that the authors noted are that school-year– and school-district–specific differences unrelated to the SLIV program could have influenced the findings, and that vaccination coverage estimates relied on caregiver reports, which can be unreliable.
Aug 18 PLOS Med study

Massachusetts confirms second eastern equine encephalitis case of year

Health officials in Massachusetts recently reported the second eastern equine encephalitis (EEE) case of the year, involving a woman in her 60s from Hampden County, located in the western part of the state near Springfield.

In a statement, the Massachusetts Department of Health (MDH) said as a result of the case it raised the risk level to critical for Wilbraham, a suburb of Springfield, and to high for the cities of Hampden and Monson. It also raised the level to moderate for five other cities in the counties, including Springfield.

Massachusetts reported its first case of the mosquito-borne disease on Aug 3, which involved a boy who was exposed in Plymouth County, located in the southeastern part of the state. Last year, the United States experienced an active year for EEE transmission, with Massachusetts reporting 12 cases, 6 of them fatal.

The US Centers for Disease Control and Prevention (CDC) said the nation averages about 11 EEE cases a year, with 38 reported in 2019, with Massachusetts hardest-hit. Transmission is most common in and around freshwater hardwood swamps in Atlantic and Gulf Coast states and in the Great Lakes region.
Aug 15 MDH statement
Aug 3 MDH statement
CDC background information

COVID-19 Scan for Aug 18, 2020

News brief

Reading levels of US, global COVID-19 websites too high for many

A review of 18 US and international public health and governmental websites with COVID-19 information for the public—including those of the World Health Organization and the US Centers for Disease Control and Prevention (CDC)—has found that all exceeded the recommended reading level and used sentence structures and technical terminology that would hinder understanding.

The review, published today in JAMA Network Open, used five common readability formulas and health readability guidelines to evaluate the websites of three public health agencies and 15 official governmental sites of countries with English-language guidelines and at least 5,000 confirmed coronavirus cases as of Apr 5.

The American Medical Association, the National Institutes of Health, and the CDC recommend that public health information be written at an eighth-grade reading level or lower.

All 149 web pages evaluated were written at levels above the eighth grade by at least one metric, and 141 (95%) were written above that level by all five metrics. Of the 149 pages, 145 (97%) used sentence structures too complex to be understood by eighth-grade readers.

Of the CDC pages reviewed, the median Flesh-Kincaid grade level was 11, median syllables per word were 1.7, median words per sentence were 15.6, and 67 pages contained at least one difficult-to-understand term (median number of difficult terms, 11).

All US states' websites evaluated were written above the eighth-grade level and used substantially more difficult terms than those of the CDC. Nine of the 10 states with the highest illiteracy rates had information exceeding a 10th-grade reading level.

The authors said that CDC resources' lower level of complexity may reflect the influence of governmental oversight mandating that public information be easily understood.

"Nonadherence to readability standards may have a greater influence in communities with lower health literacy, potentially exacerbating the disparate effects of the pandemic," the researchers wrote. "As such, efforts should focus on the urgent development of plain-language COVID-19 resources that conform to established guidelines for clear communication and are more accessible to all audiences."
Aug 18 JAMA Netw Open research letter

Study: COVID-19 inflammatory syndrome in kids not Kawasaki disease

The multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 appears to be an abnormal immune response to the novel coronavirus, similar to but distinct from Kawasaki disease, according to a research letter published today in Nature Medicine.

Led by researchers at King's College London, the study evaluated the clinical characteristics and immune profiles of 25 UK children hospitalized for MIS-C from Apr 27 to May 25.

Seventeen of 25 children (68%) had antibodies against SARS-CoV-2, the virus that causes COVID-19, in their serum, suggesting previous coronavirus infection; they also had more severe illness than those without detectable antibodies. Of the 8 children without coronavirus antibodies, 6 had previous symptoms characteristic of COVID-19, infected household contacts, or parents who were healthcare workers or had attended a large gathering.

Children in the acute phase of MIS-C illness had elevated levels of interleukins, interferon-gamma, and lymphocytes, indicating inflammation and immune responses.

Eighteen of 25 children (72%) had gastrointestinal symptoms, 7 (28%) had pneumonia, 14 (56%) needed infusions of drugs to regulate blood pressure, and 7 (28%) had enlarged or weakened coronary arteries. Median age was 12.5 years.

Children in this cohort had few commonalities with those with Kawasaki disease, who are usually much younger (1 to 3 years) and don't often have the gastrointestinal symptoms or heart muscle dysfunction seen in children with coronavirus antibodies. Also, children with MIS-C had different immune profiles than those typically seen in Kawasaki disease.

"Based on our cohort characteristics and the immune cell changes we observed, MIS-C is likely to be a distinct immunopathogenic illness associated with SARS-CoV-2, with more severe illness in seropositive children," the authors wrote. "The mechanisms underpinning these immune abnormalities are of priority for further research."
Aug 18 Nature Med research letter