More botulism cases tied to weight loss procedure reported in Europe

News brief

In an update yesterday, the European Centre for Disease Prevention and Control (ECDC) said 20 more cases of botulism linked to a weight loss procedure performed in Turkey have been reported in Germany, France, and Switzerland.

The 87 cases of the neuroparalytic illness reported since late February have all been tied to intragastric injection of the botulinum neurotoxin (BoNT) for the treatment of obesity at two private hospitals in Istanbul and Izmir from February 3 through March 1. Investigations by Turkish authorities have revealed that licensed BoNT products were used off-label for treatment of obesity at the two facilities. The relevant departments at both hospitals have had their activities suspended.

Of the confirmed cases, 53 have been reported in Turkey, 30 in Germany, 2 in Switzerland, and 1 each in France and Austria. Several of the case patients have been hospitalized, with a number reported to have been admitted to intensive care units and treated with botulinum anti-toxin.

BoNT products, such as Botox, are derived from the bacterium Clostridium botulinum and are commonly used for cosmetic purposes or for treatment of muscle spasticity. Excessive doses of BoNTs can cause botulism.

The ECDC is warning European Union/European Economic Area citizens to avoid intragastric treatments with BoNT for obesity in Turkey and is encouraging people who traveled to Istanbul or Izmir for the procedure in February to seek medical advice if they experience weakness or difficulty breathing and/or swallowing.

UK COVID positivity differed by ethnic, religious, and social factors over time

News brief

A British study suggests that Bangladeshi, Pakistani, Muslim, and Sikh groups tested positive for COVID-19 at higher rates than their White and Christian counterparts during surges driven by the Alpha and Delta variants.

In the observational study, published yesterday in BMJ Medicine, a team led by Office for National Statistics researchers examined COVID-19 rates among more than 39 million people aged 10 years and older in England from September 1, 2020, to May 22, 2021 (Alpha) or May 23 to December 10, 2021 (Delta). Average age was 47 years, and 82% were White.

Changing risk patterns

A total of 14.8% of the study population tested positive for COVID-19 during the study. During the Alpha wave, the fully adjusted relative risks of a positive test were highest among Bangladeshi and Pakistani ethnic groups (rate ratios [RRs] vs the White British group, 1.75 and 1.69, respectively).

Relative to the Christian group, the fully adjusted RRs for COVID-19 among Muslim and Sikh religious groups were 1.51 and 1.64, respectively. Other risk factors for a positive test included social deprivation, disadvantaged socioeconomic status, residence in a nursing home, and low English language proficiency.

The disparities among groups varied over time, with an increased relative risk of positivity among Christian, White British, socioeconomically advantaged, and nondisabled people during the Delta wave.

"Changes in the rate ratios observed in wave three compared with wave two could also be due to changes in testing behaviours in response to rollout of vaccination, changes in the perceived risk of infection or reinfection, and policy changes related to isolation periods and compensation after testing positive for SARS-CoV-2," they wrote.

In a related editorial, Felix Chilunga, PhD, and Charles Agyemang, PhD, both of Amsterdam University Medical Centres, called for identification of the reasons behind the decline in risk among disadvantaged populations during the Delta wave. "Answers to these questions might help policymakers in the United Kingdom with the necessary tools to institute relevant public health interventions," they wrote.

FDA expected to authorize second bivalent COVID booster for risk groups

News brief

The Food and Drug Administration (FDA) within the next few weeks will authorize second bivalent (two-strain) COVID vaccine boosters for the highest risk groups, officials with knowledge of the plans told the Washington Post.

The boosters will be authorized for people who are at least 65 years old or have weakened immune systems and given at least 4 months after the first bivalent booster. FDA officials told the post that the policy change will be "permissive" rather than a formal recommendation. The Centers for Disease Control and Prevention (CDC) is expected to endorse the FDA's action, but it's not clear if its vaccine advisory group will meet to discuss the issue.

In January, the FDA's vaccine advisory committee proposed a plan for annual COVID boosters in the fall for the majority of people, which would involve an updated version of the vaccine. However, given waning protection from mRNA vaccination, there has been some concern that such a plan could leave vulnerable groups with little protection until then. Some countries, including the United Kingdom, have already rolled out second bivalent booster doses for the highest risk groups.

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