One dose of Jynneos mpox vaccine 86% effective, study suggests

News brief

The estimated vaccine effectiveness (VE) of one subcutaneous dose of the Jynneos mpox vaccine among men in Israel was 86%, suggests an observational, real-world study published yesterday in Nature Medicine.

A team led by Clalit Health Services researchers in Tel Aviv examined the electronic health records of 2,054 men eligible for a Jynneos dose on Jul 31, 2022, 1,037 (50%) of whom were vaccinated during the study and completed at least 90 days of follow-up. The age range was 18 to 42 years.

The authors noted that the US Food and Drug Administration (FDA) recommends that Jynneos be given as two doses 4 weeks apart, but amid low vaccine supplies, many countries have been giving mpox patients a single subcutaneous dose (underneath the skin, into the fat layer) followed by a smaller intradermal dose (just underneath the outer, epidermal layer of skin).

However, the efficacy of any dosage of the vaccine, a third-generation smallpox vaccine, against mpox hasn't been proven in human clinical trials. During the now-waning global outbreak, first recognized in May 2022, 85,449 men in 110 countries have been diagnosed as having mpox, and 89 have died. The vast majority of mpox patients in the outbreak have been men who have sex with men.

Few infections overall

During the study, mpox infections were confirmed in five vaccinated participants (9.3 per 100,000 person-days), compared with 16 in the unvaccinated (4.3/100,000) (hazard ratio, 0.14). The estimated, adjusted VE was 86% (95% confidence interval, 59% to 95%).

Completing the second vaccine dose, per the approved label, may improve this effectiveness and provide longer-lasting protection.

"Our results suggest that a single dose of subcutaneous MVA-BN [Jynneos] in this high-risk cohort is associated with a significantly lower risk of MPXV [mpox virus] infection," the authors wrote. "Nevertheless, completing the second vaccine dose, per the approved label, may improve this effectiveness and provide longer-lasting protection."

The authors did not directly control for sexual behaviors among study volunteers, but they factored in data that could serve as a surrogate, such as previous sexually transmitted infections and receipt of HIV drugs. They called for randomized, controlled trials to produce direct evidence of VE.

CDC investigating deadly outbreak of multidrug-resistant Pseudomonas tied to eye drops

News brief

The Centers for Disease Control and Prevention (CDC) is investigating a multistate outbreak of carbapenem-resistant Pseudomonas aeruginosa linked to eye drops and one death.

In a Jan 20 statement, the CDC said it identified 56 isolates of Verona integron-mediated metallo beta-lactamase and Guiana extended-spectrum beta-lactamase­–producing carbapenem-resistant P aeruginosa (VIM-GES-CRPA) from 50 case patients in 11 states from May 17, 2022, to Jan 19. Thirty-eight cases are part of four facility clusters. Whole-genome sequencing data indicate that all isolates are closely related.

The isolates were collected in outpatient and inpatient healthcare settings in California, Colorado, Connecticut, Florida, New Jersey, New Mexico, New York, Nevada, Texas, Utah, and Washington. The isolates were associated with multiple different infection types, including eye infections, and colonization. Patient outcomes include permanent vision loss and one death from a bloodstream infection.

Review of common exposure among patients revealed that most patients used artificial tears prior to the identification of VIM-GES-CRPA infection or colonization, with EzriCare Artificial Tears the most commonly used brand. Lab testing of the product by the CDC identified the presence of VIM-GES-CRPA in opened bottles.

In a statement today, EzriCare said, "As of today, we are not aware of any testing that definitively links the Pseudomonas aeruginosa outbreak to EzriCare Artificial Tears. Nonetheless, we immediately took action to stop any further distribution or sale of EzriCare Artificial Tears."

We immediately took action to stop any further distribution or sale of EzriCare Artificial Tears.

In addition to carbapenem resistance, isolates in the cluster are resistant to ceftazidime and cefepime, and a subset of isolates is also resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The CDC says P aeruginosa strains harboring both VIM and GES genes have not previously been observed in the United States.

The CDC is asking clinical labs that identify any CRPA from an ocular specimen or VIM-CRPA from any specimen to submit the isolates to the Antimicrobial Resistance Laboratory Network for further analysis.

Global COVID-19 cases down, but deaths on the rise

News brief

Global COVID-19 cases have declined 78% over the past 28 days, but deaths rose 65% over the same period, with trends influenced by activity in the Western Pacific, especially in China, the World Health Organization (WHO) said today in its latest weekly update on the pandemic.

The WHO said it is switching to 28-day intervals to more accurately portray whether COVID-19 activity is picking up or slowing down. It added, however, that it still reports weekly cases and deaths on its COVID-19 dashboard.

Over the past 4 weeks, cases declined across all six WHO regions. Deaths were up in three regions: the Western Pacific, the Eastern Mediterranean, and the Americas. Over the past 4 weeks, China reported 62,759 more deaths. Much smaller increases were reported by the next two countries with the most deaths over the past 4 weeks, the United States and Japan.

The WHO urged caution in interpreting the trends, due to reduced testing and delays in reporting.

BA.5 and descendants still dominant

In its update on Omicron variants, the agency said BA.5 and its descendant lineages—which includes BQ.1 and BQ.1.1— are still dominant, making up 65.7% of sequenced samples. XBB.1.5, a recombinant of two BA.2 subvariants, makes up 11.5%.

The WHO said variant proportions vary by region, with BQ.1 and BQ.1.1 most common in Africa, the Americas, and Europe, XBB.1 most common in the Eastern Mediterranean and Southeast Asia, and BA.5.2 most common in the Western Pacific.

Pilot study identifies risk factors for Candida auris colonization

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A pilot study conducted at three New York City healthcare facilities identified patients with risk factors for Candida auris colonization, researchers with the New York State Department of Health (NYSDOH) reported yesterday in the American Journal of Infection Control.

The project, developed by NYSDOH in response to the emergence of the multidrug-resistant yeast in state healthcare facilities, implemented admission screening for C auris at ventilator units in two nursing homes (NHA and NHB) and three high-risk units at an acute care facility (Hospital C) from November 2017 through November 2019. Screening involved collecting two swabs from newly admitted patients and testing them for C auris using a real-time polymerase chain reaction (rt-PCR) test, and collecting data on patients admitted to ventilator units at NHA and NHB. The aim was to determine whether screening was feasible and to identify risk factors for C auris colonization.

Of the 2,726 screening encounters analyzed, 188 patients (6.9%) tested positive for C auris by rt-PCR. Rates of C auris were higher among admissions to NHA (20.7%) and NHB (22%) than Hospital C (3.6%). But within Hospital C, the highest rates were found in the ventilator/pulmonary unit (5.7%). In all three facilities, most positive patients were admitted from other healthcare facilities.

Individuals at NHA and NHB who had a drain placed were significantly more likely to test positive for C auris, while patients admitted to Hospital C with clinical risk factors of intubation, central venous line, a drain, or receipt of antifungal medication within 7 days of admission were more likely to test positive.

"The data collected in this pilot, including risk factors and prior location, can be used by facilities to help inform targeted admission screening strategies," the study authors wrote.

They note, however, that while targeted screening is a valuable tool for identifying C auris colonization and creating units for high-risk patients, it required substantial effort by staff and does not guarantee the absence of internal C auris transmission.

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