New research from the University of Michigan shows that patients with sickle-cell disease completed the initial COVID-19 vaccination series at just over half the rate of others, despite the former group being more at risk for severe outcomes with COVID-19.

The study, published this week in JAMA Network Open, is based on vaccine data recorded by the Michigan Sickle Cell Data Collection Program (MiSCDC). A total of 3,424 people in Michigan over age 5 with sickle-cell disease were compared to 9.4 million Michiganders over age 5 without the disease.

Only a third with sickle cell fully vaccinated

By August 2022, only 33.5% of Michiganders with sickle-cell disease had gotten the primary series of COVID-19 vaccines, compared with 61% of the Michiganders without the disease. Seventeen percent of children ages 5 to 11 with sickle-cell disease had been vaccinated, compared with 25% of their counterparts. Among 12- to 17-year-olds, the numbers were 31% and 41%, respectively.

It is essential to develop targeted interventions to increase COVID-19 vaccination among people with sickle cell disease.

Among those 65 and older, 74% of those with sickle-cell disease were vaccinated, compared to 87% for the general population. However, only 110 study participants with sickle-cell disease were in that age-group.

"It is essential to develop targeted interventions to increase COVID-19 vaccination among people with sickle cell disease," says MiSCDC principal investigator Sarah Reeves, PhD, in a press release on the findings. "This population is chronically underserved in healthcare and society, emphasizing the importance of increasing the accessibility and acceptability of these vaccines."

The findings from a randomized clinical trial in Spain support de-escalation of antibiotic therapy in patients with bacteremia caused by Enterobacterales, researchers reported yesterday in The Lancet Infectious Diseases.

Although empiric treatment with antipseudomonal beta-lactams is often necessary with severe infections to ensure that the causative organism is covered, these drugs can exert selection pressure for resistance mechanisms and increase the risk of Clostridioides difficile, which is why de-escalation to a narrower-spectrum drug is recommended once the infecting pathogen has been identified. But the dearth of evidence on the safety and efficacy of de-escalation in specific clinical situations has been a barrier to wider acceptance of the practice.

To determine the safety and efficacy of de-escalation in patients with bacteremia caused by Enterobacterales, investigators randomly assigned trial participants to de-escalate to one of several antibiotics according to susceptibility (the de-escalation group) in the first 48 hours after the antimicrobial susceptibility report was available or to continue with empiric treatment (the control group). The primary outcome was clinical cure 3 to 5 days after end of treatment. The non-inferiority margin was –10%.

Potential ecological benefit

Of the 344 patients assigned to the treatment groups, 164 patients in the de-escalation group and 173 in the control group were included in the modified intention-to-treat (mITT) population. Analysis of the primary outcome showed that 90% of patients in the de-escalation group had clinical cure, compared with 89% in the control group, for a risk difference of 1.6 percentage points (95% confidence interval, –5.0 to 8.2).

Given the potential ecological benefit, these results provide evidence to implement active actions to promote de-escalation in this clinical setting.

The number of adverse events reported was 219 in the de-escalation group and 175 in the control group, with 24% and 32% considered severe, respectively. Five percent of patients in the de-escalation group and 6% in the control group died during the 60-day follow-up, but no deaths were treatment-related.

The investigators note that the most frequent sources of bacteremia were the urinary and biliary tracts, so the results apply mainly to those populations.

"Given the potential ecological benefit, these results provide evidence to implement active actions to promote de-escalation in this clinical setting," they wrote.

Chronic wasting disease (CWD) has been detected in another Wyoming elk hunt area, according to the Wyoming Game and Fish Department (WGFD).

In a news release yesterday, WGFD said the fatal neurodegenerative infection was confirmed in a hunter-harvested cow elk in Elk Hunt Area 28 in late December. The hunt area is in the Lander area in the central part of the state and borders Elk Hunt areas 98 and 127, where CWD was confirmed in 2021 and 2022, respectively.

In 2022, WGFD tested 6,701 lymph node samples from deer, elk, and moose, most of them hunter-submitted.

Caused by misfolded proteins called prions, CWD isn't known to infect humans or other non-cervid animals, but experts worry it could jump species. The Centers for Disease Control and Prevention recommends against consuming meat from obviously ill animals or those that test positive for CWD.

With the start of 2024, highly pathogenic avian flu outbreaks have already been confirmed in four states, with California the hardest-hit state, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

In California, the virus was detected at three more commercial farms, including a layer pullet farm in Merced County housing more than 760,000 birds, a broiler farm in Merced County that has nearly 535,000 birds, and a broiler farm in Sonoma County that has nearly 78,000 birds. Also, officials reported an outbreak involving two of the state's backyard flocks, one in Merced County and the other in Sacramento County.

Meanwhile, two other states reported outbreaks affecting commercial farms. Wisconsin reported an event at a turkey facility in Washburn County that has 41,000 birds, and in Kansas, the virus hit a layer pullet farm in Rice County that was raising 240,000 birds. Colorado reported an outbreak in a backyard flock in Arapahoe County.

So far this year avian flu outbreaks have led to the loss of 1.66 million birds, APHIS said. The H5N1 outbreaks began in US poultry in February 2022 and have so far led to a record loss of 81.37 million birds across 47 states.