News Scan for Sep 15, 2020

News brief

New guidelines issued for S aureus prevention, control in NICUs

The Centers for Disease Control and Prevention (CDC) has issued new recommendations for the prevention and control of Staphylococcus aureus in neonatal intensive care unit (NICU) patients.

The guidelines are based on current understanding of the transmission dynamics of S aureus in the NICU and were developed through a systematic review of the best available literature available through August 2019. The review was guided by questions about the most effective strategies for preventing S aureus transmission from colonized or infected NICU patients, which sampling sites and laboratory assays most effectively identify colonization in NICU patients, and what risk factors exist for S aureus infection in NICU patients.

The guidelines recommend performing active surveillance testing at regular intervals for S aureus colonization in NICU patients when there is increased evidence of infection or in an outbreak setting, and for methicillin-resistant S aureus colonization when there is evidence of ongoing healthcare-associated transmission. Active surveillance can be conducted using either culture-based or polymerase chain reaction detection methods, and samples should be collected from the nostrils. The authors conditionally recommend testing of infants from other newborn care units, and targeted decolonization for colonized NICU patients.

S aureus is the most common healthcare-associated pathogen in US NICUs, with an estimated incidence of up to 45 infections per 100,000 hospitalized infants, and rates of invasive S aureus infection are especially high in preterm and low birthweight infants. While infants may acquire the bacteria as part of their normal developing microbiota, those who are colonized with S aureus are at increased risk of infection.

A companion document from the Society for Healthcare Epidemiology of America (SHEA), published yesterday in Infection Control and Hospital Epidemiology, answers some of the questions that clinicians may have about S aureus detection and prevention in the NICU.
September CDC recommendations
Sep 14 SHEA white paper

US kids gaining ground on HPV vaccine coverage, but gaps remain

An analysis of 15 years' worth of US insurance data on human papillomavirus (HPV) vaccination in nearly 8 million girls and boys found increasing uptake, but that levels are still shy of targets with differences that vary by state. A team based at Harvard University published its findings yesterday in Pediatrics.

The investigators looked at HPV vaccination information from the MarketScan healthcare database from January 2003 to December 2017, examining one- and two-dose coverage by birth year, sex, and state. The team also examined associations between state vaccination policies and vaccine coverage. The study included 7,837,480 children.

For 15-year-old girls, one-dose coverage rose from 38% in 2011 to 57% in 2017, and over the same period, coverage in 15-year-old boys rose from 5% to 51%. For two doses over the same years, coverage increased from 30% to 46% in girls and from 2% to 39% in boys. As an example of differences in regional coverage, two-dose coverage in 2017 ranged from 80% for girls in Washington, DC, to 15% for boys in Mississippi. The team also found a positive correlation between uptake and HPV education legislation and pediatrician availability.

In a related commentary in the same issue, Amanda Dempsey, MD, PhD, MPH, with the University of Colorado, said the study was well powered to look at differences in vaccination coverage, was positioned to look at coverage over time, and assessed about 800,000 kids who were continuously insured.

She notes that those features yielded two unique insights: that vaccination levels were reached faster as the years went by and that one-dose coverage is projected to reach 80% by 2022 in 17-year-olds, when many haven't been exposed to disease-causing HPV types—a major public health victory.
Sep 14 Pediatrics study
Sep 14 Pediatrics commentary

COVID-19 Scan for Sep 15, 2020

News brief

Small study finds benefit from convalescent plasma in severe COVID-19

Preliminary data from a small study published today in Nature Medicine suggests convalescent plasma may have some efficacy in patients with severe COVID-19.

The retrospective, propensity score-matched case-control study involved 39 patients who received convalescent plasma for severe or life-threatening COVID-19 at Mount Sinai Hospital in New York from Mar 20 to Apr 20. The patients, who were an average age of 55 and had few baseline comorbidities other than obesity (mean mass body index, 31.7), received convalescent plasma under compassionate use guidelines an average of 4 days after admission. For the analysis, they were matched 1:4 to 156 control patients admitted during the same period.

Convalescent plasma recipients and control patients were 100% matched on supplemental oxygen requirements on day 0, but by day 14 after transfusion, oxygen requirements had worsened in 17.9% of convalescent plasma patients, compared with 28.2% of the control patients (adjusted odds ratio [OR], 0.86; 95% confidence interval [CI], 0.75 to 0.98; chi-square test P value = 0.025). At the end of the study, 12.8% of the convalescent plasma patients and 24.4% of the control patients had died. Following adjustment for the duration of symptoms before admission and exposure to therapeutic anti-coagulation and broad-spectrum antibiotics, the analysis showed significant survival benefit for convalescent plasma (adjusted hazard ratio, 0.34; 95% CI, 0.13 to 0.89; chi-square test P = 0.027).

No serious adverse events were judged to be caused by convalescent plasma transfusion. The authors say larger, randomized studies are needed to confirm the findings.

"This initial assessment offers evidence in support of convalescent plasma transfusion as an effective intervention in COVID-19," they write. "Preliminary data suggest a mortality benefit, but greater numbers and a randomized trial design are needed to draw definitive conclusions about the efficacy of convalescent plasma for the treatment of COVID-19."

Convalescent plasma was granted emergency use authorization by the Food and Drug Administration in August, but critics, including an expert panel gathered by the National Institutes of Health, say there are insufficient data to recommend for or against the use of convalescent plasma for COVID-19 treatment.
Sep 15 Nat Med study

Loneliness, isolation doubled among older adults early in pandemic

Twice as many older adults—who are at high risk for serious COVID-19 outcomes—reported feeling lonely and isolated in the first months of the pandemic than in 2018, a new University of Michigan poll shows.

The university's National Poll on Healthy Aging team asked a national sample of more than 2,000 adults aged 50 to 80 about changes in loneliness and the number of social interactions outside of their household from March to June. Chronic loneliness is associated with declines in memory, physical and mental health, and longevity.

After comparing the results with those of a similar poll from October 2018, the team found that 56% of respondents reported feeling isolated, versus 26% in the earlier poll. Forty-six percent said they had social interactions once a week or less, up from 28% in 2018, and 41% felt a lack of companionship, compared with 34% in 2018.

The 46% of respondents who said they had contact with people in their neighborhood once a week or more were less likely than others to report feeling lonely. Technology also helped foster a sense of connection, with 59% of participants logging on to social media and 31% using video chat once a week or more.

Participants who reported loneliness were less likely to engage in healthy behaviors than the 75% who reported spending time in nature and the 62% who said they exercised several times a week.

Poll director Preeti Malani, MD, said in a news release that the difference in responses between the 2 years is remarkable. "The use of technology to bridge the gap, and the importance of keeping up healthy routines like exercise, sleep, a balanced diet and getting outside, will no doubt continue to be important in the months ahead," she said.

Poll team member John Piette, PhD, said in the release that the findings show the importance of paying attention to how society supports the social and emotional needs of older adults. "The intersection of loneliness and health still needs much study, but even as we gather new evidence, all of us can take time to reach out to older neighbors, friends and relatives in safe ways as they try to avoid the coronavirus," he said.
Sep 14 University of Michigan Poll results and news release