Healthcare use and medical costs increased in the year following COVID-19 infection in healthy adults, even among those who weren't hospitalized, a Pfizer-based research group reported late last week in BMC Medicine.

The team examined medical records of 3,792 adults ages 18 to 64 from an Optum database who were diagnosed as having COVID-19 from April 1, 2020, to May 31, 2020. They compared healthcare use and costs before and after infection. They examined three cohorts: people who weren't hospitalized, those who were hospitalized without intensive care unit (ICU) admission, and those who were admitted to the ICU.

Patients with underlying conditions were excluded from the study, and researchers from the same group had conducted a similar study on patients with COVID who had chronic conditions that was published the previous day in the same journal.

Blood-related diagnoses up 150%

Among the previously healthy adults, healthcare burden in the year following COVID infection increased in all subgroups, even in those who hadn't been hospitalized. Similar to the companion chronic disease study, the greatest increases involved new blood-related diagnoses, which increased more than 150% compared to the baseline period.  New diagnoses for neurologic and psychological conditions also increased following COVID infection. Respiratory disease declined 27%, but were offset by a large rise in chronic respiratory conditions.

Different from the study in the high-risk patients, healthy adults had a 123% increase in endocrine, nutritional, and metabolic diseases and a 76% increase in digestive conditions. Researchers observed an increase in prescriptions for hormone medications, especially ones to treat joint stiffness and muscle pain, as well as vascular and musculoskeletal agents.

Costs were also higher after COVID infection compared to baseline, similar to the study in chronically ill patients. "Even among those who were not hospitalized during the acute phase of COVID-19, inpatient visit costs during the post-acute phase increased by 578%, outpatient visit costs increased by 139%, and total medical costs increased by 138%," they wrote.

Researchers show that the passage of a bill in New York state that banned nonmedical vaccine exemptions for school entry was associated with an increase in vaccine uptake outside of New York City, according to a study late last week in JAMA Network Open.

The bill, Senate Bill 2994A, was passed by state lawmakers in June 2019 after two large measles outbreaks in the state almost removed the country's measles elimination status. The bill was effective immediately and did not excuse students with existing nonmedical exemptions from compliance.

The study was based on school immunization compliance data from the 2012-13 through 2021-22 school years. Included were all public and private schools outside of New York City to look at trends in both school vaccine coverage (defined as the percentage of students at each school who completed grade-appropriate requirements for all required vaccines) and medical exemption uptake (defined as the percentage of students at each school who received a medical exemption), the authors said.

A total of 3,632 schools were including in the final analysis.

Small but significant immunization increase

The post-2019 implementation of Senate Bill 2994A was associated with absolute increases in mean vaccine coverage of 5.5% (95% confidence interval [CI], 4.5% to 6.6%) among nonpublic schools and 0.9% (95% CI, 0.7% to 1.1%) among public schools.

The authors estimate Bill 2994A resulted in an annual mean increases of 1.0% among nonpublic schools and 0.3% among public schools estimated through the 2021 to 2022 school years, and the increases were statistically significant.

A legislative repeal of school-entry nonmedical vaccination exemptions can be effective in increasing vaccination compliance without replacement by new medical exemptions.

"These findings suggest that a legislative repeal of school-entry nonmedical vaccination exemptions can be effective in increasing vaccination compliance without replacement by new medical exemptions,” the authors concluded.

A randomized clinical trial conducted in US and Canadian hospitals found that a skin antiseptic containing iodine reduced surgical-site infections in patients with fractured limbs by more than 25% compared with an antiseptic containing chlorhexidine gluconate, researchers reported last week in the New England Journal of Medicine.

The investigators say the results could prompt changes in the type of antiseptic used in surgery to repair simple fractures. While some guidelines favor chlorhexidine gluconate, previous studies comparing the antiseptics in other surgical populations had provided conflicting results.

"The results of this well-designed study provide some long overdue clarity to orthopaedic trauma surgeons with respect to which commonly used antiseptic skin preparation is more effective when preparing for fracture surgery," study co-author Todd Jaeblon, DO, of the University of Maryland School of Medicine, said in a university press release. 

26% reduction in surgical-site infections

In the cluster-randomized trial, 25 US and Canadian hospitals were randomly assigned to use a solution of 0.7% iodine povacrylex in 74% isopropyl alcohol (the iodine group) or 2% chlorhexidine gluconate in 70% isopropyl alcohol (the chlorhexidine group) as an antiseptic before surgery to repair extremity fractures. Every 2 months, the hospitals alternated interventions. The primary outcome was surgical-site infection.

The trial included 6,785 patients with a closed fracture and 1,700 with an open fracture. In the closed-fracture population, surgical-site infection occurred in 2.4% of patients in the iodine group and 3.3% in the chlorhexidine group (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.55 to 1.00). In the open fracture population, surgical-site infection occurred in 6.5% of patients in the iodine group and 7.3% in the chlorhexidine group (OR, 0.86; 95% CI, 0.58 to 1.27), but the difference was not considered statistically significant. The frequencies of unplanned reoperation, 1-year outcomes, and adverse events were similar in both groups.

The investigators say that, with more than 1 million fractured limbs treated surgically each year in the United States, using iodine povacrylex as an antiseptic could potentially prevent surgical-site infections in thousands of patients.

The results of this well-designed study provide some long overdue clarity to orthopaedic trauma surgeons with respect to which commonly used antiseptic skin preparation is more effective when preparing for fracture surgery.

• The US Centers for Disease Control and Prevention (CDC) today announced the opening of its new East Asia and Pacific regional office in Tokyo, which is designed to strengthen the US government's global health impact through collaboration with Japan, partner countries, and regional groups to prevent, detect, and respond to health threats. The director of the new regional office is Michelle McConnell, MD, who had worked with an Asian regional office in the global health division of the US Department of Health and Human Services. CDC Director Mandy Cohen, MD, was on hand for an opening ceremony in Tokyo, alongside Japan's health minister, the US ambassador to Japan, and representatives from international organizations and academic centers.
• Testing in Spain have identified variant H1N1 swine flu in a man from Catalonia who works on a pig farm, according to the latest weekly communicable disease report from the European Centre for Disease Prevention and Control (ECDC). His symptoms began in late November, and he sought outpatient care three times over the following 3 weeks. On December 12, tests on an oropharyngeal sample revealed an unsubtypable influenza A virus, which was identified by Catalonia's regional lab as swine influenza H1N1. The patient has fully recovered, and no other cases have been detected. The sample was sent for confirmation to the National Institute of Microbiology, and the isolate will be shared with the World Health Organization (WHO) collaborating center. Human infections with swine flu viruses occur sporadically and are usually mild. The ECDC said cases in people who have contact with pigs isn't surprising, but health officials track contacts to monitor any possible onward spread.
• Animal health officials in Laos have temporarily closed a large live-bird market in Vientiane, the country's capital and largest city, owing to detections of H5N1 and H9N2 avian flu in poultry. An agriculture ministry statement detailing the detections and closure was translated and posted by Avian Flu Diary, an infectious disease news blog. Samples that tested positive were from chickens, ducks, and their environments. Another group of samples from sick birds yielded H5N1 and H9N2 subtypes. Meanwhile, the WHO and the United Nations Food and Agriculture Organization late last week warned of a higher risk to humans during preparations and travel for Lunar New Year celebrations because of ongoing reports of avian flu detections in the Asian region's wild birds and poultry. The groups urged people to limit their exposure to poultry and their environments and encouraged health departments to boost their surveillance, especially in high-risk areas.