Plague outbreak in DRC sickens 45, some with pneumonic symptoms

A plague outbreak in the Democratic Republic of the Congo (DRC) that began on June likely involves all three types, including pneumonic, and has so far resulted in 45 cases, 9 of them fatal, the World Health Organization (WHO) said yesterday in a statement.

Plague is endemic in Ituri province, and since the first of the year, officials have reported 64 cases and 14 deaths across five of its health zones, including Rethy. Disease levels this year are up sharply from the 10 cases and 5 deaths that were reported in all of 2019, with only one affected health zone.

The first case in the Ituri province outbreak involved a 12-year-old girl who was seen at a local health center on Jul 12 for headache, fever, cough, and an enlarged lymph node. She died the same day, followed by community deaths in people with similar symptoms.

An investigation found that, of 45 patients, 2 had signs of septicemic plague and the rest were diagnosed as having the bubonic form. However, 9 patients, including 4 who died, had cough, suggesting that bubonic infections may have progressed to pneumonic plague.

The WHO raised concerns that COVID-19 activity, scarce resources, and insecurity in Ituri province may affect plague response activities. Currently, the reference lab in Bunia, the provincial capital, isn't operating, which could delay case confirmation. The agency also said it has little information on access to healthcare and whether patients in Ituri province may seek care in Uganda.
Jul 23 WHO statement

Ebola infects 3 more in DRC, 65 total, with 29 deaths

Three more Ebola cases, along with two more deaths, have been confirmed in an outbreak in Equateur province in the DRC, the WHO African regional office said on Twitter.

The developments push the outbreak total to 65 cases, 61 of them confirmed and 4 listed as probable, and 29 deaths. The new cases appear to be from Mbandaka, the provincial capital, which is located on a river and has travel connections to Kinshasa and neighboring countries.
Jul 24 WHO African regional office tweet

In a related development, UNICEF warned yesterday that the number of children who have lost parents who died or are separated from parents undergoing screening or treatment is rising fast in the Equateur province outbreak. In a statement, it said the response needs to be stepped up, but so far it hasn't received any funding to battle the latest outbreak.

UNICEF said it and partners have helped 10 children in temporary protection, but urgent support is needed to build nurseries close to Ebola treatment centers. The organization estimates that it needs $6.98 million for response activities; so far, it has drawn $2 million from its own resources to fund the response until it gets additional funding.
Jul 23 UNICEF press release

Three countries report more polio cases

In its latest weekly update, the Global Polio Eradication Initiative (GPEI) said Afghanistan, Pakistan, and Chad have reported new polio cases.

Afghanistan reported 5 more wild poliovirus type 1 (WPV1) cases, 1 in Hirat province and 2 each in Kandahar and Urozgan provinces, raising the total for the year to 35. Neighboring Pakistan reported 2 new WPV1 cases, in Balochistan and Punjab, lifting the country's 2020 total to 60.

Chad reported 3 more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases, 1 each in Logone Occidental, Tandjile, and Wadi Fira provinces, putting its total this year at 55 from two outbreaks, one of them linked to Nigeria's Jigawa outbreak.
Jul 23 GPEI update

In related developments, polio vaccination campaigns in the WHO Eastern Mediterranean region resumed this week, following a 4-month pause on all vaccination activities due to the COVID-19 pandemic. Noting that vaccination will be done with strict infection prevention and control measures, the agency said Pakistan on Jul 20 launched a small-scale campaign in targeted districts with a goal of vaccinating nearly 800,000 children.
Jul 20 WHO EMRO statement

New biobank to study bacteria resistant to last-resort antibiotics

Scientists in Luxembourg this week announced the creation of a new biobank that will collect and analyze strains of bacteria from Europe that are resistant to last-resort antibiotics.

Mirabank, a joint project of the Integrated Biobank of Luxembourg (IBBL) and the Laboratoire National de Santé (LNS) launched on behalf of the European Centre for Disease Prevention and Control, will receive roughly 4,000 strains of carbapenem- and colistin-resistant bacteria from 37 European countries in the coming months, starting with strains from Luxembourg's four hospitals. The strains will be stored at IBBL, and LNS will then conduct genomic analysis for a better understanding of the genetic and epidemiologic mechanisms of the strains.

"This project is of great importance in the fight against resistance to antibiotics of last resort, as carbapenem resistance is a problem that has particularly increased in Europe in recent years and needs to be studied for the health of patients in Europe," Kristin Kornerup, PhD, of IBBL said in a press release. "We are very pleased to provide our expertise for this project, and to do so with the LNS." 
Jul 22 LNS press release

UK study identifies sepsis risks, antibiotic benefits, in primary care

Research by a team of UK scientists indicates that the risks of sepsis and the benefits of antibiotics following common infections in primary care are greater among older adults, in severely frail patients, or following urinary tract infections (UTIs), according to a study yesterday in PLOS Medicine.

The cohort study analyzed electronic health records of all registered patients at 706 general practices identified in a large UK clinical database from 2002 to 2017. The researchers identified 35,244 first episodes of sepsis following consultations for respiratory tract infection (RTI), skin infections, or UTIs.

Using a Bayesian decision tree to estimate the probability of sepsis following an infection consultation, they found a lower probability if an antibiotic was prescribed, but that the number of antibiotic prescriptions required to prevent one episode of sepsis (number needed to treat, NNT) decreased with age. At 0 to 4 years old, the NNT was 29,773 (95% uncertainty interval [UI], 18,458 to 71,091) in boys and 27,014 (95% UI, 16,739 to 65,709) in girls; over 85 years old, NNT was 262 (95% UI, 236 to 293) in men and 385 (95% UI, 352 to 421) in women.

The analysis also revealed that frailty was associated with a greater risk of sepsis and lower NNT. For severely frail patients aged 55 to 64 years, the NNT was 247 (95% UI, 156 to 459) in men and 343 (95% UI, 234 to 556) in women. At all ages, the probability of sepsis was greatest, and the NNT lowest, for UTI, followed by skin infection and RTI.

The authors of the study say the findings could be used by antimicrobial stewardship programs to identify groups of consultations in which the reduction of antibiotic prescribing can be pursued more safely.

"The potential risk of antimicrobial resistance has a significance that extends beyond the context of an individual consultation," they wrote. "Prescribing decisions must therefore be informed by the balance of all of the benefits and harms of either prescribing or not prescribing antibiotics. Quantification of the possible risks of sepsis contributes to informing these decisions."
Jul 23 PLOS Med study

Study finds no transmission of COVID-19 from moms to newborns

A study yesterday in The Lancet Child & Adolescent Health found no evidence of COVID-19 transmission between 120 babies born to mothers with COVID-19, even after 2 weeks of breastfeeding with appropriate hygiene precautions.

The findings led the American Academy of Pediatrics (AAP) to change its guidance on infants and COVID-19–positive mothers. The guidelines now recommend that newborns "room-in" with infected others after delivery if proper hygiene precautions are taken, including wearing a mask when appropriate and practicing hand hygiene.

The small observational study was based on 120 babies born to 116 mothers at three hospitals in New York City, between Mar 22 and May 17. The babies were kept in enclosed cribs in their mothers' hospital rooms, and mothers wore surgical masks while handling their babies and followed frequent hand and breast washing procedures.

None of the babies tested positive for COVID-19 24 hours after birth. Follow-up at 5 to 7 days post-birth and through the first month of life showed no infections.

In a commentary on the study, Melissa Medvedev, MD, of the University of California San Francisco, said the authors of the study "provide valuable data indicating that perinatal SARS-CoV-2 transmission is unlikely, and allowing newborns to room-in and breastfeed is safe, with appropriate precautions." But Medvedev cautioned more studies are needed to quantify the incidence of complications among pregnant women and newborns.
Jul 23 Lancet Child Adolesc Health study
Jul 22 AAP guidance
Jul 23 Lancet Child Adolesc Health commentary

Study finds higher COVID-19 diagnoses, deaths in counties with more Latinos

COVID-19 diagnosis rates are greater in disproportionally Latino counties, but risks and deaths among Latino populations differ by region, US researchers reported yesterday in the Annals of Epidemiology.

For the study, researchers compared predictors of COVID-19 cases and deaths between counties where Latinos made up more than 17.8% of the population and all other US counties through May 11. They also looked at the heterogeneity of the US Latino population and explored whether differences in a set of core demographic variables play a role in COVID-19 diagnoses and deaths.

Their analysis showed that COVID-19 diagnosis rates were greater in disproportionately Latino counties nationally (90.9 vs 82.0 per 100,000 population), and that COVID-19 diagnoses and deaths increased with the proportion of Latinos living within a given county, particularly in the Midwest and Northeast. In a multivariable analysis that adjusted for other predictors of COVID-19, the adjusted rate ratio [aRR] for Latino counties in the Northeast was 1.42 (95% confidence interval [CI], 1.11 to 1.84) and 1.70 (95% CI, 1.57 to 1.85) for Latino counties in the Midwest. COVID-19 deaths were higher in Midwestern Latino communities (aRR, 1.17; 95% CI, 1.04 to 1.34).

The analysis also found that higher rates of COVID-19 cases were associated with a greater proportion of monolingual Spanish speakers (aRR, 1.28; 95% CI, 1.16 to 1.42), higher heart disease death rates (aRR, 1.o7; 95% CI, 1.o1 to 1.14), less physical distancing (aRR, 0.72; 95% CI, 0.64 to 0.81), and more days since the first case was diagnosed (aRR, 1.90; 95% CI, 1.80 to 2.01). COVID-19 deaths were associated with crowded living conditions (aRR, 1.13; 95% CI, 1.04 to 1.22) and elevated air pollution (aRR, 1.23; 95% CI, 1.03 to 1.47).

The authors suggested the higher death rate in Latino Midwest counties could be linked to Midwestern meat and poultry processing facilities, which employ many Latino migrants. They say the findings call for "focused and energetic" policy responses.

"Our analyses provide a timely proxy for assessing the impact of COVID-19 on Latino communities and affirm the importance of Latino tailored prevention, care, and focused efforts to meet the needs of Latino individuals and communities," they wrote.
Jul 23 Ann Intern Med study

Pilot study evaluates use of dogs for SARS-CoV-2 detection

A small pilot study suggests trained scent-detection dogs have the potential to be used for mass detection of people infected with SARS-CoV-2, the virus that causes COVID-19, German researchers reported yesterday in BMC Infectious Diseases.

In the study, eight dogs were trained for 1 week to detect SARS-CoV-2 from saliva or tracheobronchial secretions of patients infected with the virus. During the training, dogs were presented with positive and negative samples (confirmed by RT-PCR tests) using a device with seven scent holes with tubes leading to metal containers that held the samples. Only one hole had a container with a positive sample, and the other six had containers with control samples. After a week, the researchers conducted a double-blind, randomized controlled trial.

During the presentation of 1,012 randomized samples, the dogs achieved an overall detection rate of 94% (plus or minus 3.4%), with 157 correct indications of a positive sample, 792 correct rejections of a negative sample, and 33 false-positive and 30 false-negative indications. The dogs discriminated between infected and non-infected people with an overall diagnostic sensitivity of 82.63% (95% CI, 82.02% to 83.24%) and specificity of 96.35% (95% CI, 96.31% to 96.39%). There was no noticeable difference in detection ability between saliva and tracheobronchial secretions.

The authors of the study note several limitations, including the fact that the positive samples were from patients with severe COVID-19. They say future research should focus on samples from mild, pre-symptomatic, and asymptomatic patients. In addition, the samples were inactivated, and because it's still unclear whether dogs can spread the virus to humans, using them for testing in the field could be problematic. The authors say they are developing strategies for secure presentation of non-inactivated samples.

"Further work is necessary to better understand the potential and limitation of using scent dogs for the detection of viral respiratory diseases," they wrote.
Jul 23 BMC Infect Dis study